AVP, General Manager - Medicare - NY/NJ

CVS Health; New York (NY); On-site; USD 157,000 - 364,000; Full time

Job summary

An established industry player is seeking an AVP, General Manager to lead Medicare market strategies and ensure financial performance. This role requires a deep understanding of the Medicare landscape and a proven track record in business management. The successful candidate will spearhead initiatives that drive growth, compliance, and operational excellence while fostering a diverse and inclusive workforce. Join a forward-thinking organization committed to transforming health care and making a meaningful impact on communities. If you're passionate about health solutions and leadership, this opportunity is tailor-made for you.

Benefits

Affordable medical plan options

401(k) plan with matching contributions

Employee stock purchase plan

Wellness screenings

Tobacco cessation programs

Weight management programs

Confidential counseling

Financial coaching

Tuition assistance

Flexible work schedules

Qualifications

• 10+ years of experience in business management, especially in Medicare.
• Strong financial focus with P&L expertise.

Responsibilities

• Lead Medicare programs for profitability and growth.
• Oversee financial performance and compliance with regulations.

Skills

Medicare business knowledge

P&L expertise

Leadership skills

Business problem-solving

Insurance regulatory knowledge

Value-based provider contracting

Cross-functional collaboration

Education

Bachelor’s degree in business

Healthcare administration degree

Job description

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

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, General Manager who has Medicare market specific P&L accountability for the IVL/DSNP products in their market, 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 Market GM 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.

Responsibilities

• Responsibility for supporting Medicare programs with short-and-long term profitability and growth of the health plan.
• Spearheading the implementation of new contracts, programs, services, and preparation of bid and grant proposals.
• Responsibility for the overall financial performance and achievement of the budget of the Medicare plans within the Market.
• Direction of senior leaders 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. Coordinating and monitoring functional integration of these areas in cooperation with corporate departments to achieve planned business results.
• Leading all departments in the development, implementation and maintenance of policies and procedures to ensure compliance with the State and Federal regulatory requirements.
• Responsibility for the plan performance related to all required State and Federal audits.
• Responsibility for the management and organization of plan activities at the health plan as it relates to the Medicare business.
• Monitoring the budget in assigned functional areas and takes corrective actions when necessary.
• 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. Ability to lead teams and drive performance in a dynamic and fast-paced environment.
• Partnering effectively within the team and across the organization to ensure strategic initiatives stay aligned to plan and elevate solutions to barriers and decisions needed to executive leaders at the highest levels of organization.
• Creating and executing a sustainable, and profitable-growth strategy.
• Accountability for working with Medicare segment functional areas for monthly results, bid execution and other MAO responsibilities.
• 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

• 10+ 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.
• 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.
• Knowledge of insurance regulatory and contractual requirements.
• Knowledge of value 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.
• 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.
• Residence in/near the market (New York or New Jersey) or willing to relocate.
• Demonstrate a commitment to diversity, equity, and inclusion through continuous development, modeling inclusive behaviors, and proactively managing bias.

Education
Bachelor’s degree in business, healthcare administration, or a related field.

Pay Range

The typical pay range for this role is: $157,800.00 - $363,936.00. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits.

We anticipate the application window for this opening will close on: 04/11/2025.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.