Sr. Principal Clinical Leader - Aetna MI and IL Integrated Plans - RN or BH

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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 Duals segment is a significant driver of profitable growth within government programs at Aetna. Continued growth in this segment will require sustainable approaches to scaling a compliant, efficient and effective clinical care management operation. To provide this leverage and support, F/HIDE SNP clinical operations require focused leadership and accountability to manage a complex regulatory environment and a challenging operation that includes 500+ staff and multiple vendor partners. The Senior Principal Clinical Leader provides strategic leadership and operational oversight for clinical care management across Aetna's Michigan and Illinois Integrated Plans. Location This role is fully remote. Eligible candidates may live anywhere in the contiguous United States but preference will be given to applicants living in Michigan. Travel This role will require up to 10% travel for conferences, auditing, and stakeholder visitations. Fundamental Components & Physical Requirements Lead the strategic growth and enhancement of applicable CM program capabilities Inform model of care and workflow best practice in the development of new technology platforms and tools Collaborates with executive leadership throughout the organization to develop and implement program strategies that meet business, CMS, federal and state regulations as well as accrediting agency requirements Responsible for cross-functional integration of care and case management, utilization management, program operations with core Responsible for cost savings and quality improvement projects through successful implementation. Leads and manages all aspects of projects and/or programs. Ensures the use of a formal project plan and collaborative workgroups are used in demonstrating the achievement of the project implementation goals. Deliver operational performance and compliance Accountable for relationship management with relevant state authorities and the development, vetting and reporting of state compliance and quality measures and achievement of measure goals. Accountable for managing processes, communication and results of internal and external processes. Leads a team that promotes high standards of operational practice through advancement of policies, procedures, practice guidelines and alignment of clinical and business processes and practices Responsible for the implementation and revision of medical management letters ensuring that letters are compliant with CMS, federal and state regulations as well as accrediting entities. Responsible for relationship management for vendors; ensures targets are achieved and medical management goals are met. Manage operations staff and develop workforce and organization Lead recruitment and operating model development to meet operational growth needs; Develop and implement staffing models that are consistent, cost effective and meet all compliance obligations. Oversee all workforce and operational readiness needs related to clinical system migrations / implementations. Lead, develop, motivate and manage a high performing team to meet organizational goals and objectives while effectively managing change. Lead effectively in a matrixed environment with critical business functions provided by shared service divisions (eg Engagement Hubs, Member Service Operations) Lead a virtually integrated staff (including clinical and non-clinical members) within multiple geographic markets. Foster an environment that supports professional development, mobility and operational Required Qualifications Active unrestricted clinical license in applicable functional area. (e.g. RN, LCPC, LCSW) 10+ years Managed Care experience required; Medicare and Medicaid including LTSS and DSNP, highly preferred 7+ years of Care Management operations and leadership experience, including leading leaders and developing high-performing teams. Leading change in a growth business Experience leading the strategic design, execution, and outcomes management of Care Management programs, with a demonstrated ability to drive clinical and financial performance. Experience planning, leading and organizing the resources of a large and growing team and developing talent. Preferred Qualifications Ability to synthesize program performance and clinical outcome Ability to evaluate and interpret data for the purpose of developing new programs and processes to meet business demands Ability to communicate in a highly effective manner with internal and external constituents in both written and oral format Education & Licensure If Behavioral Health - Master's degree in a field leading to independent Behavioral Health licensure If Registered Nurse - Masters' degree or equivalent* experience, MSN preferred. *Equivalent years of experience defined by CVS Policy: If candidate has associate’s degree, additional 4 years of experience is needed. If candidate has bachelor’s degree, an additional 2 years of experience is required. Pay Range The typical pay range for this role is: $123,857.00 - $266,770.00 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 full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being 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: 10/03/2026 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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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...

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