Job details

Job Type

Contract

Full Job Description

  • Fully accountable leader, charged with managing Medicare Individual market performance, delivering Individual growth and managing Medicare Individual costs in alignment with strategy and ops plan goals.

  • Responsible for achieving target market position, overall financial performance of the Medicare Individual plans within the Market, and local execution of STARs, compliance, and revenue yield in collaboration with corporate teams.
  • Drives local product strategy, local market intelligence, and cost structure reduction (SAIs) in collaboration with Medicare leadership, the market president(s) and related teams.
  • Manages Medicare sales, operations, contracts, provider relations, network development, utilization management, quality improvement and coordinates and monitors functional integration of these areas in cooperation with corporate departments to achieve planned business results.
  • Directs all departments and teams in the development, implementation and maintenance of policies and procedures to ensure compliance with State and Federal regulatory requirements.
  • Responsible for the plan performance related to all required Federal audits.
  • Monitors budget in assigned function areas and takes corrective action.
  • Coaches, mentors, and manages performance of team members; drives talent development and actively builds bench. Creates a customer focused culture and collaborates across the organization to ensure internal and external constituent needs are met.
  • Serves as Ambassador for increasing Medicare market knowledge.
  • Promotes cultural awareness and sensitivity matching needs of communities served or key roles.


Required Qualifications

  • Knowledge of insurance regulatory and contractual requirements
  • 3-5 years of solid Medicare Advantage experience
  • P&L expertise and strong financial, bottom-line focus
  • Previous Medicare Advantage sales and business development experience
  • Strong facilitative leadership and business problem solving skills
  • Ability to effectively interact with a diverse workforce and cross functional groups
  • Ability to deal effectively with multiple internal and external clients
  • Licensure as required by state


Preferred Qualifications

  • Deep knowledge of local markets in the States of GA, AL, LA & MS
  • Work location: Atlanta, Georgia
  • Experience working in a matrixed environment
  • Previous experience working for a large, national carrier
  • Previous experience with Dual Special Needs Plans


Education

Bachelor’s Degree required. Master’s Degree preferred.

Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.