AVP, Chief Medicare Officer
The Medicare CMO has market specific P&L accountability for the IVL/DSNP products in their market, driving Sales and customer experience agendas in their 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 STARs, compliance, and revenue integrity efforts for all Medicare Advantage products (inclusive of EGWP) in collaboration with corporate teams. The Market CMO 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 leadership, and the market president(s) and related teams.
Responsible for the overall financial performance and achievement of Budget of the Medicare plans within the Market
Directs managers and/or directors of specific functional areas as assigned. Functional areas may include operations, sales, marketing, provider relations, network development, utilization management, and/or STARS/HEDIS quality improvement, and Revenue Integrity efforts. Coordinates and monitors functional integration of these areas in cooperation with corporate departments to achieve planned business results
Directs all departments in the development, implementation and maintenance of policies and procedures to ensure compliance with the State and Federal regulatory requirements.
Responsible for the plan performance related to all required State and Federal audits.
Responsible for the management and organization of plan activities at the health plan as it relates to the Medicare business
Monitors budget in assigned function areas and takes corrective action.
Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including, employment, termination, performance reviews, salary reviews, and disciplinary actions
Creates and Executes and sustainable, and profitable-growth strategy
Accountable for working with Medicare segment functional areas for monthly results, bid execution and other MAO responsibilities
The typical pay range for this role is:
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
• 10+ of relevant experience in line of business management.
• Deep knowledge of the Medicare business
• Must have P&L expertise and possess a strong financial, bottom-line focus.
• Ability to deal effectively with multiple internal and external clients.
• Ability to effectively interact with a diverse workforce and cross functional groups.
• Background in health care industry and/or insurance highly desired.
• Knowledge of insurance regulatory and contractual requirements.
• Knowledge of current health care marketplace dynamics and Aetna’s position in the market.
• Knowledge of Aetna’s operations and marketing processes and strategies.
• Advanced Degree
• Bachelor's Degree
• Licensure as required by state
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CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. 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.