Serves as a key strategic advisor to the Aetna 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-Aetna enterprise alignment of clinical operations, policy, staffing, and operating standards.
Leads development of the enterprise Aetna Medical Affairs operating model, spanning utilization management, appeals, care management, care model design, clinical pathways, network alignment, and quality programs.
Designs and oversees dashboards, KPIs, and scorecards for all Aetna Medical Affairs functions and leverages those data points to optimize and drive performance.
Oversees operational budgets, including monitoring, forecasting, and cost-management activities.
Leads end-to-end operational integration across Aetna Medical Affairs, ACS, Network, Technology, Analytics, and business-unit clinical teams.

12+ 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.

Affordable medical plan options
401(k) plan (including matching company contributions)
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.

AVP, Chief Operating Officer, Medical Affairs

Key skills