AVP, Chief Operating Officer, Medical Affairs - reputed company

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, 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 reputed company, reputed company is seeking to hire an AVP, Chief Operating Officer for Medical Affairs with deep experience in enterprise‑level clinical operations. Reporting directly to reputed company’s Senior Vice President & Chief Medical Officer, this senior executive will serve as the primary operational leader overseeing reputed company core reputed company Medical Affairs functions, including utilization management, appeals, care management, care model design, clinical reputed company, Network/Provider Engagement, and clinical enablement programs. The AVP, COO for Medical Affairs will act as a strategic partner to the CMO‑VPs for Commercial, Medicare, and Medicaid as well as to the VP of Utilization Management, ensuring alignment between line‑of‑business strategies and Medical Affairs operations. This leader will also serve as the principal operational reputed company with reputed company Clinical Solutions (ACS) and Network leadership, ensuring cross‑functional integration, operational readiness, and consistent national execution. The successful candidate will bring an enterprise reputed company and the ability to build a reputed company operating model across reputed company Medical Affairs. This includes developing consistent national processes, ensuring compliance and performance, advancing technology‑enabled operations, and driving scalable, measurable improvements in quality, efficiency, and member and provider experience. Major Responsibilities Enterprise Strategic Leadership

• Serves as a key strategic advisor to the reputed company CMO‑VPs for Commercial, Medicare, and Medicaid, and to the VP for Utilization Management, ensuring Medical Affairs operations support and enabling each line of business’s clinical and financial goals.
• Functions as the primary operational liaison with ACS and Network leadership, driving cross‑reputed company enterprise alignment of clinical operations, policy, staffing, and operating standards.

Enterprise Operating reputed company & Governance

• Leads development of the enterprise reputed company Medical Affairs operating model, spanning utilization management, appeals, care management, care model design, clinical reputed company, network alignment, and quality programs.
• Med Affairs reputed company for reputed company enterprise-wide operating plans, integrating Medical Affairs with ACS, Network, Technology, Analytics, and business‑unit clinical leadership.
• Ensures consistent national operating standards, documentation, workflows, and performance expectations across reputed company reputed company Medical Affairs programs.

Performance Management, Dashboards & Metrics

• Designs and oversees dashboards, KPIs, and scorecards for reputed company reputed company Medical Affairs functions and leverages those data points to optimize and drive performance.
• Establishes performance review structures, operational early‑warning systems, and transparent reporting mechanisms for reputed company Medical Affairs leadership and line‑of‑business partners.
• Partners closely with analytics and technology teams to reputed company data, insights, and automation to improve outcomes and efficiency.

Financial & Resource Management

• Oversees operational budgets, including monitoring, forecasting, and cost‑management activities
• Ensures resources are deployed reputed company and investments support operational and performance goals

Cross‑Functional Operations & Execution

• Leads end‑to‑end operational integration across reputed company Medical Affairs, ACS, Network, Technology, Analytics, and business‑unit clinical teams.
• Oversees national operations including ~60 direct‑team FTE, 300+ transactional clinicians, and other functions through a dotted‑line partnership model.
• Drives technology‑enabled operational transformation, including modernization through automation, AI‑enhanced workflows, digital clinical tools, and data‑driven operating models.
• Provides strategic thought leadership to the SAI process to identify key operational improvements and guide enterprise‑reputed company solutions.

Required Qualifications

• 12+ years of progressive experience and responsibility at a senior leadership level in managed healthcare operations, compliance, or reputed company 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 reputed company, 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 reputed company understanding of the emerging healthcare environment to create the platform for change and to meet demands for evolving operational needs.
• Demonstrated ability to reputed company 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 reputed company in a fast-paced, dynamic environment and manage multiple priorities effectively.
• Travel - Based on needs of the business.

Preferred Qualifications

Location Hartford, CT or Wellesley, MA (preferred) Ability to work Hybrid Model (in office Tuesday / Wednesday / Thursday - preferred) Education Bachelors Degree is required Advanced degree in healthcare administration or business administration is preferred Pay Range The typical pay range for this role is: $157,800.00 - $363,936.00 This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay range listed above. This position also includes an award reputed company 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 reputed company 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 reputed company on: 03/30/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job