AVP, Chief Medicare Officer - Georgia Gulf States

CVS Health•Isle of Hope, GA

1d•$157,800 - $363,936•Hybrid

About The Position

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 At Aetna, our health benefits business, we are committed to helping our members achieve their best health in an affordable, convenient, and comprehensive manner. Combining the assets of our health insurance products and services with CVS Health’s unrivaled presence in local communities and their pharmacy benefits management capabilities, we’re joining members on their path to better health and transforming the health care landscape in new and exciting ways every day. Aetna is recruiting for an AVP, Chief Medicare Officer who has Medicare market specific P&L accountability for the IVL/DSNP products in Georgia, Alabama, Mississippi, Louisiana, and Arkansas, supporting Sales and customer experience agendas in market as well as Go-To Market planning and acquisition cost. This position is the leader for market performance, cost structure and local execution of medical costs management, compliance, and revenue integrity efforts for all Medicare Advantage products (inclusive of collaborating with the Employer Group team for EGWP products to achieve sales and client satisfaction goals) in collaboration with corporate teams. The Chief Medicare Officer will drive local product strategy and local market intelligence, be responsible for achieving target market position, market share growth, and drive cost structure reduction (SAIs) in collaboration with Medicare segment leadership, the market medical teams, Network Management teams and other related teams.

Requirements

10+ years of leadership experience managing Medicare Advantage within a Medicare Advantage Organization (MAO).
Deep understanding of Medicare Advantage operations, strategy, and market dynamics.
Strong P&L management experience with a demonstrated focus on financial performance and growth.
Knowledge of insurance regulatory, compliance, and contractual requirements.
Experience with value-based and risk-based provider contracting models.
Proven ability to build relationships and collaborate effectively with internal and external stakeholders across a matrixed organization.
Strong strategic thinking, problem-solving, and facilitative leadership skills.
Demonstrated success leading, developing, and coaching high-performing teams, including people leaders.
Ability to influence, engage, and drive results through cross-functional partnerships and executive-level collaboration.
Understanding of the Medicare Advantage competitive landscape and market trends.
Must reside in the Southeast and be able to travel within the market as needed.
Hybrid work arrangement requiring three days per week in the office and residence within 25 miles of an Aetna office location.

Responsibilities

Drive the Medicare business’s short- and long-term growth, profitability, and overall market performance.
Lead the implementation of new contracts, programs, and services, including bid and grant proposal development.
Accountable for Medicare plan financial performance, budget achievement, and profit and loss results.
Provide strategic leadership to senior functional leaders across operations, sales, marketing, provider relations, network development, utilization management, quality (STARS/HEDIS), and revenue integrity.
Ensure alignment and integration across business functions and corporate partners to achieve strategic and operational goals.
Lead the development, implementation, and maintenance of policies and procedures to ensure compliance with all state and federal regulations.
Oversee plan readiness and performance for state and federal audits.
Direct and coordinate Medicare business operations and organizational activities across the health plan.
Monitor financial performance, manage budgets, and implement corrective actions as needed.
Build, lead, and develop high-performing teams, including managers, while fostering accountability, engagement, and talent development.
Partner across the organization to drive strategic initiatives, remove barriers, and elevate key decisions to executive leadership.
Develop and execute sustainable growth strategies that deliver long-term profitability.
Collaborate with Medicare segment partners to support monthly performance reviews, bid execution, and other Medicare Advantage operational requirements.