Lead Director, Operational Analytics
4062 Aetna Resources, LLCWe’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.
**This position can be remote or hybrid depending on candidates location to an office*
Position Summary
The Aetna Healthcare Affordability team is looking for a dynamic leader who has extensive experience providing performance management analytics within clinical and network operations. This position is responsible for producing internal operating metrics on the Healthcare Affordability team with a focus on opportunities, risks, and successes. This position will have to work across business and technical functions to identify needs, solutions and proposals to stand up summary reports to be used by the Healthcare Affordability team. They will forge relationships across the Aetna ecosystem and leverage the entire CVS enterprise where needed to identify data sources and processes to collate information and present in a user-friendly format to support total cost of care initiatives.
More specifically, in this role, you will:
Lead the operational reporting efforts on the Healthcare Affordability team
Work with the clinical strategists to identify performance metrics of each of their workgroups, identify opportunities and assist in developing performance metrics to gauge the success of their workgroup
Produce executive-level summaries of overall performance and opportunities of the HcA team
Integrate with the broader Healthcare Affordability team to ensure consistent tracking and reporting of work
Support the story-telling and opportunities available for all the Total Cost of Care programs being managed by the HcA team
Prepare summary metrics for reporting to senior leaders the opportunities and risks in meeting year-end goals
Support ideation for long-term cost of care strategies and analytic needs
Comfortable working with Medical and Clinical staff within Aetna CM/UM, Medical Policy, and Clinical Informatics.
Works with MEU and other enterprise analytic teams to identify new data, metrics or views needed to support affordability, quality and outcomes improvement initiatives
Partner with clinical and medical directors to identify, assess and prioritize potential scorable action items
Work across the Aetna business to identify sources of healthcare cost and trend data currently available in all lines of business: Commercial, Medicare and Medicaid
Analyzes data, healthcare trends and provides suggested actions from data
Work closely with Medical Economics Unit (MEU), Analytical & Behavior Change (A&BC), and other areas that have currently available analytic tools to identify sources of healthcare cost and utilization trend and SAI performance data
Develop internal tools, using Power BI, ThoughtSpot or similar solution to bring in high level data points from disparate data sets across Aetna to be used in understanding cost trends and drivers in support of Hotspot and POD ideation teams
Work with leaders across business units to identify data sources and solutions available to support total cost of care initiatives
Works with finance, data engineering and IT to bring solutions and ideation to completion
Supports business unit’s ideation and business case strategy with analytic thought leadership, modeling and suggestions
Required Qualifications
A minimum of 10 years of direct healthcare experience within a large payer organization, with a focus on healthcare analytics, program evaluation, or outcomes measurement
Proven track record of developing analytic solutions and operating effectively within a cross-functional, matrixed environment
Demonstrated ability to adapt and perform in a dynamic, evolving business landscape
Ability to identify performance gaps and translate business needs into actionable analytic solutions
Experience in clinical and provider-based analytics, including forecasting, trend analysis, and projections
Experience working with claims data, including detailed line-item analysis and payment operations
Familiarity with CM (Care Management), UM (Utilization Management), and other clinical operations and provider datasets
Solid understanding of clinical workflows, chronic disease management, care management programs, and value-based care (VBC) concepts
Excellent written and verbal communication skills, with the ability to translate complex technical findings into clear insights for non-technical stakeholders
Prior people management experience, including coaching, development, and training of team members, is preferred
Experience with data visualization and analytics tools such as Tableau, ThoughtSpot, or Quickbase is a plus
Preferred Qualifications
Strong proficiency in SAS and SQL, and/or Microsoft Power BI, with at least 5 years of experience designing and developing Power BI solutions—preferably leveraging clinical operations or provider utilization data.
Experience in healthcare or managed care environments
Experience partnering with Medical Economics, Behavioral Health, or Population Health teams
Familiarity with causal inference and impact evaluation methodologies
Experience supporting or implementing value-based care (VBC) models
Working knowledge of interoperability concepts and data integration
Experience developing analytic solution roadmaps, including identifying risks and opportunities
Education
Bachelor’s Degree preferred or a combination of education and experience.
Pay Range
The typical pay range for this role is:
$100,000.00 - $231,540.00
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.