CVS Health
Senior Clinical Strategist - Aetna Payment Integrity – Ideation & Affordability
$96K–$206K
CT - Hartford · Remote/Hybrid · Senior · Full-time · Posted Oct 30, 2026
- Experience
- Minimum 5 years of relevant healthcare experience.
- Education
- Master’s degree or equivalent experience; BSN preferred. CVS Policy defines equivalent experience as 4 additional years with an associate’s degree or 2 additional years with a bachelor’s degree.
About the job
Identifies and validates clinical and payment-integrity opportunities to improve healthcare affordability, payment accuracy, and clinical integrity, then develops recommendations for prioritization and implementation.
What you'll do
- Research clinical, coding, reimbursement, policy, and utilization trends to identify payment-integrity opportunities.
- Validate concepts with clinical evidence, claims data, analytics, and financial opportunity; develop business cases and requirements.
- Collaborate across clinical, analytical, operational, technical, and business teams and present recommendations for governance.
What they ask for
- Active, unrestricted clinical license in an applicable healthcare discipline.
- Current nationally recognized professional coding certification, such as CPC, CCS, CCS-P, CIC, or COC.
- Minimum 5 years of relevant healthcare experience.
- Demonstrated experience in payment integrity, medical policy, claims editing, clinical or coding validation, or healthcare affordability.
Nice to have
- Registered Nurse (RN).
- Experience with medical-cost trends, claims or clinical analytics, payment-integrity vendors, or reimbursement environments.
Pay
$95,738.00 - $206,206.00 USD base annual full-time salary; eligible for a CVS Health bonus, commission or short-term incentive program (amount not stated)
Tools
CPT, HCPCS, ICD
Model-written summary · the original posting is authoritative