Executive Director, Medicare Revenue Management

CVS Health•Hartford, CT

2d•$131,500 - $303,195•Hybrid

About The Position

This role serves as the single financial owner of Medicare Revenue for Medicare Advantage and Medicare Part D, accountable for the end‑to‑end translation of member acuity, program policy changes, corporate revenue-focused initiatives, and risk adjustment outcomes into forecasted and booked revenue. The role aligns directly to Finance accountability for forecasts, accruals, and earnings explainability and is designed to strengthen accuracy, transparency, and decision discipline when estimating revenue outcomes. The Executive Director of Medicare Revenue Management partners closely with Revenue Integrity (RI), Actuarial, and Product Finance but owns the financial modeling, projections, accruals, and variance explanations reflected in forecast, close, and executive reporting.

Requirements

10+ years of experience in healthcare finance, actuarial, or advanced analytics.
Expertise in Medicare Advantage and Part D risk adjustment economics and CMS payment mechanics/timing.
Demonstrated ownership of forecasts, accruals, and financial explainability.
Experience translating complex analytics into executive-level insights.
Proven ability to lead high‑performing, cross‑functional teams.
Bachelor's Degree

Nice To Haves

Actuarial credentials (ASA/FSA), advanced quantitative degrees (e.g., MS in Statistics, Data Science, or Health Economics), or other credentials demonstrating strong analytical and healthcare reimbursement expertise.
Experience supporting Medicare bids or CMS‑related financial processes.
Experience leading or scaling analytical capabilities within Finance.

Responsibilities

Own the enterprise financial modeling framework for Medicare Advantage and Part D (MA-PD) products. Establish and maintain a robust projection model and underlying assumptions. Project in‑year movement driven by member mix, documented conditions, corporate revenue-focused initiatives, and payment timing. Translate model outputs into estimated revenue impacts, sensitivity test results, and play an active role determining the final, recommended revenue accrual values.
Own all revenue-related assumptions and accrual modeling, including mid‑year accruals, final accruals, and any revenue‑impacting adjustments. Lead the development of accrual assumptions and modeling, including opportunities to enhance precision over time. Ensure accrual positions are defensible, consistently applied, and aligned with financial reporting standards.
Lead the evolution of an analytical approach that reduces aggregation noise by identifying drivers of revenue performance and understanding the amount of variability for each driver. Promote consistent standards across Finance partners, including robust documentation, structured processes, and defensible analytic approaches. Establish and execute consistent and timely feedback loops based on actual-to-expected (AtoE) outcomes, with refinement of modeling and assumptions over time.
Consume execution inputs from Revenue Integrity (activity volumes, completion rates, vendor productivity, CMS processing timing). Maintain clear separation between execution accountability (RI) and financial translation and booking accountability (Finance). Provide financial impact perspectives to inform operational prioritization and management decisions.
Present CFO‑ and ELT‑ready insights on revenue performance, risks, and outlook. Lead reviews of forecast movement, accrual changes, and key performance drivers. Maintain strong governance over assumptions, analytical standards, documentation, and audit readiness.
Lead and grow hybrid finance and technical team (analytics and modeling) sized to support enterprise Medicare needs. Act as a visible financial leader with strong judgment and executive presence. Operate as a proactive business partner focused on outcomes, not reporting volume.