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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 a VP, Medicare Territory Leader who will have overall accountability for the territory P&L and general management responsibilities for the Medicare business in the Southeast territory which includes the states of Florida, Georgia, Alabama, Mississippi, Louisiana, Arkansas, Tennessee, North Carolina and South Carolina. This leader will direct key team resources and associated project responsibilities managing Individual Medicare Advantage, Special Needs Plans (SNP) including Medicare Dual Eligible Special Needs Plans (DSNP) and Chronic Special Needs Plans (CSNP), subsequently measuring resulting organizational performance, profitability growth, and cost parameters. This role is responsible for achieving organizational target market competitive position, profit and loss (P&L) accountability, and overall financial performance of all plans in alignment with Strategic and Budget goals.
You'll make an impact by:
Leading and providing strategic direction for the delivery of measurable productivity results as well as the overall performance of respective territories.
Supporting Enterprise decisions and establish a multi-market culture, set and control the Medicare narrative across the markets, shared services partners and key internal/external communications.
Developing and executing a robust and cohesive multi-market strategy for sustainable and profitable growth while ensuring adherence of budget, and matrix partner alignment with prioritization for Sales COE, Network, Revenue Integrity, Stars, and other key functional areas.
Delivering superior financial and operational performance through routine cross-functional meetings (e.g., Quick Strikes) and local market performance improvement workgroups/onsite market deep dives; engages key stakeholders and ensures a path to execution across all markets.
Being the market interface and lead alignment and prioritization with shared services and key business partners; represent and advocate for local market needs, including participation in various strategic meetings and committees (e.g., Emerging Trend, Regional Council, Final Rule, etc.) as identified and/or directed by the Head of Medicare Markets for operational oversight of the territory.
Coordinating and leading end-to-end bid strategy development for all markets within the designated territory; including regular bid touchpoints, coordinating and organizing bid finalization during War Room, and presenting territory bid and product strategies to senior leadership as part of bid check-out and/or Executive Reviews.
Promoting business practice consistencies across the territory; establishing essential policy and standards, fostering upstream/downstream best practice identification, facilitating completion of critical Medicare milestones and deliverables, monitoring local market implementation, and fostering continuous quality improvement, ensuring norms, and best practices are benchmarked.
Ensuring multi-state Medicare/Medicaid alignment with key leadership and state agencies to anticipate future regulatory changes and identifying opportunities to build long-term strategies for success.
Responsibility for the approval of medical policy deviations and network contract rates and structures above established market guidelines.
Educating, developing, and mentoring GMs and the team to develop bench strength/future market leaders and succession planning.
Working directly with finance team on ensuring forecast for territory in sync with business leads.
Supporting CVS Health in attracting, retaining, and engaging a diverse and inclusive consumer-centric workforce that delivers on our purpose and reflects the communities in which we work, live, and serve.
Required Qualifications
The candidate will have a strong work ethic, be a self-starter, and be able to be highly productive in a dynamic, collaborative environment. This position offers broad exposure to all aspects of the company’s business, as well as significant interaction with all the business leaders. The candidate will be expected to have the following key attributes:
15+ years 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.
Experience leading change across multiple markets/states.
Ability to deal effectively with multiple internal and external clients.
Ability to effectively interact with a diverse workforce and cross functional groups.
Strong facilitative leadership and business problem solving skills are required.
Ability to deal effectively with multiple internal and external clients is required.
Knowledge of insurance regulatory and contractual requirements.
Knowledge of value and risk-based provider contracting.
Knowledge of current health care marketplace dynamics and Aetna’s position in the market.
Knowledge of Aetna’s operations and marketing processes and strategies.
Ability to effectively interact with a diverse workforce and cross functional groups required.
Experience leading and developing people, preferably leading managers. Proven team leadership experience - leadership skills to build high-performing teams, manage and develop talent, influence, and impact a broad set of stakeholders, engage, and inspire others, and lead by example.
Skilled at collaborating and working across a complex matrixed organization.
Must reside or being willing to relocate to one of the states in the market.
Demonstrate a commitment to diversity, equity, and inclusion through continuous development, modeling inclusive behaviors, and proactively managing bias.
Education
Bachelor's degree required.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.
You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through ColleagueRelations@CVSHealth.com If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.