Executive Director, Medical and Payment Policy - Aetna

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 The Executive Director, Medical and Payment Policy, serves as a visionary leader at the intersection of clinical strategy and healthcare reimbursement. This executive-level role is responsible for shaping, developing, and implementing comprehensive medical and payment policies that drive organizational objectives, regulatory compliance, and financial sustainability. The Executive Director partners with clinical, operational, legal, and financial teams to ensure that policies are evidence-based, patient-centered, and aligned with industry standards, payer requirements, and evolving healthcare legislation. Responsibilities: Policy Development and Implementation Oversee the research, drafting, evaluation, and maintenance of medical, clinical, and payment policies to ensure compliance with federal, state, and local regulations. Facilitate stakeholder engagement and incorporate feedback from internal and external partners, including clinicians, payers, patients, and advocacy groups. Monitor emerging trends in medical practice, reimbursement, and healthcare legislation to proactively update policy frameworks. Ensure policies are driven by evidence-based practices and enhance the value and quality of patient care. Regulatory Affairs and Compliance Stay abreast of regulatory requirements, legislative developments, and accrediting body standards to ensure all policies are fully compliant. Serve as the primary liaison with regulatory agencies on matters related to medical necessity, coding, coverage determinations, and payment methodologies. Lead internal audits and policy reviews to identify and mitigate compliance risks. Payment Policy and Reimbursement Strategy Design and implement innovative payment models that promote efficiency, quality outcomes, and cost-effective care delivery. Collaborate with actuaries and financial teams to analyze the impact of payment policy changes on organizational finances and provider networks. Educate internal stakeholders on payment methodologies, including fee-for-service, value-based care, bundled payment, and alternative payment models. Stakeholder Engagement and Relationship Management Build and maintain collaborative relationships with physicians, hospitals, health systems, payer organizations, government agencies, and patient advocacy groups. Represent the organization at industry conferences, regulatory hearings, and professional associations. Lead initiatives to gather and synthesize stakeholder input on policy development and policy change management. Team Leadership and Talent Development Recruit, mentor, and develop a high-performing team of policy professionals and analysts. Foster a culture of excellence, accountability, and continuous improvement. Oversee performance management, professional development, and succession planning within the department. Required Qualifications 15+ years of progressive leadership experience in healthcare policy, medical management, reimbursement, or healthcare administration. Deep knowledge of medical policy development, payment models, and the U.S. health care regulatory environment (including CMS, Medicaid, ACA, etc.). Demonstrated experience with the implementation and management of value-based care, alternative payment models, and clinical guidelines. Strong analytic, problem-solving, and decision-making skills. Proven ability to lead, influence, and collaborate effectively at all organizational levels and with external stakeholders. Exceptional written and oral communication abilities, with a track record of representing organizations at the highest levels. Experience in health economics, outcomes research, or actuarial analysis is highly desirable. Demonstrated integrity, sound judgment, and commitment to ethical practice. Education Bachelor's degree in public health, public policy, healthcare administration, or business administration. Pay Range The typical pay range for this role is: $131,500.00 - $303,195.00 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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 03/27/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.

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