Job Description

Sr Clinical Strategist

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels, and more than 300,000 purpose-driven colleagues caring for people where, when, and how they choose in a way that is uniquely more connected, more convenient, and more compassionate. And we do it all with heart, each and every day. Mission of the position: The Sr Clinical Strategist provides clinical leadership and oversight for the Aetna Better Health of Michigan as related to policy and process at the national level and market level. This position collaboratively develops, implements, supports, and monitors health strategies, policies, and programs, and supportive technology and analytics to ensure appropriate utilization. This position provides leadership and direction in the execution of the standard operating model for Care Management and associated functions to create a continuum of integrated care for physical, behavioral, and social determinates of health for our members experience. Position is fully remote. Eligible candidates must live in Michigan in one of the following counties: Clinton, Eaton, Ingham, Oakland, Macomb, Wayne, Jackson, Washtenaw, Hillsdale, Lenawee, Monroe, Van Buren, Kalamazoo, Calhoun, Berrien, Cass, St Joseph, Branch.

Overview: The Senior Clinical Strategist is a key conduit for policy and process related information for Integrated Care Management initiatives, and processes. The incumbent is tasked with updating, revising, validating, or creating policies & procedures, standard operating procedures, desktops, internal and state reporting, oversee internal Care Management projects as needed in collaboration with compliance and business leaders.

Core duties:

1. Partner with Medicaid Care Management, NCQA, Compliance and Audit leads to analyze and support performance of all relevant markets.
2. Works to establish and maintain collaborative relationships by fostering excellent customer response and appropriate problem resolution.
3. Collaborates with leadership throughout the organization to develop and implement program strategies in meeting business objectives, as well as CMS, federal and state regulations, and accrediting agency requirements across the plans in a matrix environment.
4. Demonstrates expertise in all care management processes to act as primary resource for program oversight, consultation, and audit monitoring.
5. Represents advanced level of knowledge and training related to system technology and data analytics for CM process integration.
6. Oversee and ensure compliance with all applicable Federal and State regulations relevant to the plans function.

Required Qualifications:

• Active and unrestricted Michigan Registered Nurse (RN) license.
• 4+ years of experience in Medicaid Care Management (within a managed care organization preferred).
• 4+ years of experience communicating with all levels of an organization from C-Suite executives to front-line staff (written and verbal).
• 4+ years of demonstrated experience in managing large initiatives and projects.
• 4+ years of experience building and sustaining effective relationships while collaborating with internal and external teams to enhance knowledge sharing and improve processes.
• Demonstrated leadership experience.
• Competent in data analysis and uses this to drive medical management strategy.
• Knowledge of medical management regulations, standards, and policies.
• Ability to evaluate and interpret data for the purpose of developing and revising new programs and processes to meet business demand across cross-functional teams to achieve goals and to improve plan outcomes.
• Proficient in Microsoft Office Suite products including Word, Excel, PowerPoint, and Outlook, plus a variety of other word-processing, spreadsheet, database, e-mail, and presentation software.
• Must be willing and able to travel up to 10% for state meetings approximately 2x per year but could be more depending on business needs. Reliable transportation required. Mileage is reimbursed per our company expense reimbursement policy.

Preferred Qualifications:

• Ability to manage multiple timelines and produce evidence of driving toward success with regular updates on progress in all areas of clinical project or program management.
• Participate in strategic projects and process improvements based on lessons learned.
• Profound understanding of clinical workflows and best practices.
• Ability to effectively manage expectations and inspire confidence.
• Six Sigma Black Belt or Lean Six Sigma Certification Preferred.
• Case Management Certification (CMC)

Education: Registered Nurse (Masters preferred)

Anticipated Weekly Hours 40

Time Type Full time

Pay Range The typical pay range for this role is: $87,035.00 - $187,460.00

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

We anticipate the application window for this opening will close on: 09/16/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Job Tags

Similar Jobs