Vice President Model Risk Management Jobs in Springfield, MA

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Aetna is seeking to hire a VP, Chief Operating Officer for Medical Affairswith deep experience in enterpriselevel clinical operations. Reporting directly to Aetna's Senior Vice President & Chief Medical Officer, this senior executive will serve as the primary operational leader overseeing all core Aetna Medical Affairs functions, including utilization management, appeals, care management, care model design, clinical pathways, Network/Provider Engagement, and clinical enablement programs.

The VP, COO for Medical Affairs will act as astrategic partnerto theCMOVPs for Commercial, Medicare, and Medicaid as well as to theVP of Utilization Management, ensuring alignment between lineofbusiness strategies and Medical Affairs operations. This leader will also serve as theprincipal operational interface with ACS and Network leadership, ensuring crossfunctional integration, operational readiness, and consistent national execution.

The successful candidate will bring an enterprise mindset and the ability to build a unified operating model across Aetna Medical Affairs. This includes developing consistent national processes, ensuring compliance and performance, advancing technologyenabled operations, and driving scalable, measurable improvements in quality, efficiency, and member and provider experience.

Major Responsibilities

Enterprise Operational Leadership

• Serves as a key strategic operational advisor to the Aetna CMO VPs for Commercial, Medicare, Medicaid, and Utilization Management, across both physical and behavioral health, ensuring Medical Affairs operations support and enabling each line of business's clinical and financial objectives.
• Acts as the primary operational liaison with ACS and Network leadership, driving enterprise-wide alignment on clinical operations, policy, workforce strategy, and operating standards.

Enterprise Operating Framework & Governance

• Leads development and continuous evolution of theenterprise Aetna Medical Affairs operating model, spanning utilization management, appeals, care management, care model design, clinical pathways, network alignment, and quality programs.
• Serves as the Med Affairs lead forAetna enterprise-wide operating plans, integrating efforts across ACS, Network, Technology, Analytics, and businessunit clinical leadership.
• Establishes and maintains consistent national operating standards, governance structures and documentation, workflows, and performance expectations across all Aetna Medical Affairs programs.

Performance Management, Dashboards & Metrics

• Designs and oversees dashboards, KPIs, and scorecardsfor all Aetna Medical Affairs functions, using insights to optimize and drive performance.
• Leads the strategy and execution of enterprise reporting, ensuring standardized, accurate, and actionable data for leadership and key stakeholders.
• Establishes performance review structures, operational earlywarning systems, and transparent reporting mechanisms for Aetna Medical Affairs leadership and line of business partners.
• Partners closely with analytics and technology teams to leverage data, insights, and automation to improve outcomes, efficiency clinical decision making.

Workforce Management, Planning & Operational Excellence

• Provides oversight for Aetna Medical Affairs workforce management strategy, including capacity planning, staffing models, productivity optimization, and resource allocation across Medical Affairs.
• Leads integrated workforce planning to ensure alignment with business demand, regulatory requirements, and performance expectations.
• Drives operational excellence through continuous process improvement, workload balancing, and optimization of clinician and operational team performance.

Financial & Resource Management

• Oversees Aetna Medical Affairs budget planning, forecasting, financial performance management ensuring alignment with enterprise priorities and financial targets.
• Partners with finance and business leaders to ensure transparency, accountability, and alignment between financial performance and operational outcomes
• Drives disciplined investment prioritization and cost management to support operational efficiency and value creation.
• Ensures resources are deployed efficiently and investments support operational and performance goals

Project Management Office (PMO) Leadership

• Provides executive oversight for a centralized Medical Affairs Project Management Office (PMO), ensuring disciplined execution of strategic initiatives and enterprise priorities.
• Establishes standardized project management methodologies, governance, and reporting to drive visibility, accountability, and delivery excellence.
• Ensures alignment and prioritization of key initiatives across Medical Affairs and enterprise partners.

Clinical Quality, Audit & Decision Excellence

• Leads enterprise strategy and oversight for clinical quality, ensuring consistent, evidence-based medical decision-making across all lines of business.
• Oversees audit functions, quality review processes, and governance frameworks to strengthen accuracy, compliance, and clinical integrity.
• Drives continuous improvement in clinical decision quality through analytics, feedback loops, and targeted interventions.
• Partners across Medical Affairs, ACS, and Network to ensure alignment on quality standards, audit outcomes, and performance expectations.

CrossFunctional Operations & Execution

• Leadsendtoend operational integrationacross Aetna Medical Affairs, ACS, Network, Technology, Analytics, and businessunit clinical teams.
• Oversees national operations including ~60 directteam FTE,300+ transactional clinicians, and other functions through a dottedline partnership model.
• Drivestechnologyenabled operational transformation, including modernization through automation, AIenhanced workflows, digital clinical tools, and datadriven operating models.
• Provides strategic thought leadership to the SAI process to identify key operational improvements and guide enterprisealigned solutions.

Qualifications

The candidate will have a strong work ethic, be a self-starter, and be able to be highly productive in a dynamic, collaborative environment. This position offers broad exposure to all aspects of the company's business, as well as significant interaction with all the business leaders. The candidate will be expected to have the following key attributes:

• 15+ years of progressive experience and responsibility at a senior leadership level in managed healthcare operations, compliance, or related field.
• Deep understanding of utilization management, and how it impacts healthcare quality and total cost of care.
• Deep understanding of clinical/claims systems and processes, and how they relate to member support services, payment integrity, and other connected processes.
• Deep understanding of compliance and quality programs (e.g., NCQA, HEDIS).
• Experience in addressing issues impacting member and provider experience.
• Demonstrated ability to work collaboratively across functions to align on shared goals, integrated processes, and KPIs.
• Demonstrated leadership with relevant initiatives: business process optimization, cross-functional integration, strategic operational planning, risk management.
• Proven ability to leverage understanding of the emerging healthcare environment to create the platform for change and to meet demands for evolving operational needs.
• Demonstrated ability to lead and influence cross-functionally, organize and integrate strategies, and align stakeholders on priorities and deadlines.
• Strong analytical and problem-solving skills, with a data-driven approach to decision-making.
• Ability to thrive in a fast-paced, dynamic environment and manage multiple priorities effectively.

Education

Degree, certification, or equivalent experience related to healthcare or health plan operational management. Advanced degree in healthcare administration or business administration is a plus.

Core Competencies

Able to Navigate a Complex Organization: The ideal candidate will have worked effectively in an organization of considerable size, scope, and complexity. He or she will be highly effective at partnering across boundaries, and will understand how to collaborate, influence and drive impact across the organization. This leader will have the ability to interact with and influence senior management enterprise-wide to further company objectives. The successful candidate will possess a demonstrated ability to work collaboratively across complex, multifunctional teams.

Highly Skilled Communicator with the Ability to Connect Deeply with People: The ideal candidate will possess excellent communication skills and will present his/her views in a clear and compelling manner. He/she should be a good listener who is straightforward, articulate, and open in communication with others. This executive will have the presence and credibility to win support and buy-in. He/she must create enthusiasm among the team and be able to create a rally cry around key initiatives throughout the company.

Demonstrate Excellence and Accountability: Innovate; anticipate the future; work toward continuous improvement; work cross-functionally to achieve right outcomes; create and lead with a sense of urgency; translate strategy into action.

Deliver Quality Service and Value: Build trust by creating value-added relationships with all constituents; aspire to be the best; balance the needs of all constituents; exceed constituents' expectations.

Lead Change: Inspire others; communicate a compelling vision; convince others and organizations to embrace change; negotiate skillfully; understand what motivates other people/groups.

Drive for Results: Focus on actions and outcomes; drive with energy; take initiative; remain organized and resourceful; marshal multiple/matrixed resources to get things done; possess a detail orientation.

Build Colleague Engagement: Encourage independent thinking and initiative; value diversity; build confidence and pride in the company; inspire others to contribute; create open, honest dialogue; create and communicate a vision that aligns performance with strategy; celebrate successes; express ideas effectively.

Pay Range

The typical pay range for this role is:

$250,000-$350,000

Pay Range

The typical pay range for this role is:

$0.00 - $0.00

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.

This fulltime position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial wellbeing of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

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

We anticipate the application window for this opening will close on: 07/13/2026

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