Executive Director, Data Science - Aetna Operations, Claims and Appeals Analytics

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose : Bringing our heart to every moment of your health.

This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand with heart at its center our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Position Summary

Designs and develops decision models that analyze and evaluate actual and / or potential scenarios and simulate outcomes to facilitate informed decision-making.

Leverages advanced analytical tools, decision modeling techniques, and data-driven insights to support strategic decision-making, optimize healthcare processes, and improve patient outcomes.

Major Responsibilities

• Designs and implements decision models that involve factors such as patient demographics, resource allocation, cost-effectiveness analysis, and operational optimization to capture the complexity of healthcare systems and processes.
• Conducts most complex cost-benefit analyses to assess the feasibility of new programs or technologies, evaluate potential risks and benefits, and quantify the impact of strategic decisions.
• Applies advanced analytical techniques and utilizes Decision Model and Notation (DMN) software to generate actionable insights for informing key business decisions.
• Designs systems that identify patterns, trends, and correlations in large datasets and allow for a more in-depth understanding of patient populations, healthcare utilization, treatment efficacy, and cost drivers.
• Assesses the performance of existing healthcare programs, interventions, or policies by developing evaluation frameworks, conducting statistical analyses, and measuring key performance indicators.
• Collaborates with cross-functional teams to ensure the seamless integration of decision models and decision support tools that provide actionable insights into organizational operations.
• Confers with executives, clinicians, researchers, and administrators, to provide data-driven insights and recommendations for strategic initiatives.
• Integrates the most appropriate decision science principles into the selection, design, development, and evaluation of complex decision support systems.
• Coaches and guides junior team members by educating them on innovative predictive modeling techniques that are used to inform strategic decisions and support evidence-based practices.

Required Qualifications

• 10+ years’ work experience, 5+ years people management experience
• Proven ability to apply advanced statistical methods, Machine Learning, and AI, to generate measurable business impact.
• Experience in Healthcare operations (payer and / or provider)

Preferred Qualifications

Master’s Degree or PhD preferred.

Education

Bachelor's Degree

Pay Range

The typical pay range for this role is :

$175,100.00 - $334,800.00

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.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.

The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.

The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits.

CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.

As for time off, Company employees enjoy Paid Time Off ( PTO ) or vacation pay, as well as paid holidays throughout the calendar year.

Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.