Principal Clinical Leader - Aetna Commercial CM and UM Operations - RN

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary 

This Principal Clinical Leader role is responsible for directing Care Management and Utilization Management operations for the Commercial line of business, supporting multiple dedicated plan sponsor populations. The position provides strategic oversight of clinical operations, client relationship management, operational performance, and program execution while serving as a key liaison between internal stakeholders and external clients. The leader is accountable for achieving clinical, operational, financial, and customer experience outcomes through effective team leadership, data-driven decision-making, and strong partnership with plan sponsors and enterprise business partners.

Work Schedule

• Salaried position with flexibility to work varied hours based on team needs
• Occasional weekends and holidays may be required to support business operations

Travel Requirements

Up to 25% travel, including client meetings, leadership meetings, market visits, industry conferences, team engagement events, and other business-related activities as needed.

Location

Fully remote. Eligible candidates may live anywhere in the contiguous United States.

Key Responsibilities

• Lead and oversee Care Management and Utilization Management operations within the Commercial line of business, ensuring delivery of high-quality, member-centered clinical programs that meet organizational and client expectations.
• Provide strategic and operational leadership for multiple dedicated plan sponsor populations, ensuring program performance, service excellence, regulatory compliance, and achievement of clinical, financial, and contractual objectives.
• Drive performance across a diverse team of clinical and operational leaders through effective goal setting, performance management, coaching, workforce planning, and continuous improvement initiatives.
• Serve as the primary operational leader supporting assigned Commercial plan sponsors, fostering strong relationships and acting as a trusted partner to internal and external stakeholders.
• Represent the organization in external client meetings, health plan sponsor reviews, finalist presentations, performance discussions, and strategic planning sessions.
• Collaborate with Account Management, Sales, Product, Clinical, and Operations partners to develop and execute client-specific strategies that improve member outcomes, engagement, affordability, and satisfaction.
• Oversee delivery of Utilization Management activities, ensuring compliance with regulatory, accreditation, contractual, and quality standards while promoting appropriate, evidence-based care.
• Direct Care Management program strategy and execution across complex populations, including management of clinical interventions, member engagement approaches, care planning, and outcomes measurement.
• Monitor and drive achievement of key performance indicators including engagement, quality outcomes, utilization trends, financial performance, productivity, customer experience, and service level agreements.
• Utilize data analytics and performance insights to identify opportunities, implement corrective actions, and drive operational excellence across teams and client populations.
• Lead organizational change initiatives, workforce transformation efforts, and implementation of new programs, technologies, workflows, and clinical capabilities.
• Partner closely with plan sponsors and senior leadership to understand business objectives, proactively address emerging needs, and ensure alignment between operational execution and client expectations.

Required Qualifications

• Active, unrestricted RN license in state of residence
• 10 years relevant work experience
• Minimum 8 years of progressive clinical leadership experience, including managing teams and other leaders
• Leadership experience in Case Management and/or Utilization Management, primarily within Commercial Lines of Business
• Strong understanding of Commercial healthcare benefits, employer-sponsored health plans, utilization management processes, population health strategies, and value-based care principles.
• Experience leveraging clinical and operational data to identify trends, develop actionable insights, and drive improvements in quality, member experience, utilization, and cost outcomes.
• Experience driving performance across complex operations through the use of analytics, performance management frameworks, continuous improvement methodologies, and workforce optimization strategies.

Preferred Qualifications

• At least 3 years of recent experience as a manager at Aetna
• Experience supporting national employer groups, Fortune 500 clients, or large-scale Commercial populations is highly desirable.

Education

Master’s degree equivalent clinical experience*, BSN or MSN preferred

*Equivalent years of experience defermined by CVS Policy: If candidate has associate’s degree, additional 4 years of experience is needed. If candidate has bachelor’s degree, an additional 2 years of experience is required.

Pay Range

The typical pay range for this role is:

$121,514.00 - $261,723.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.  This position also includes an award target in the company’s equity award program. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.