Executive Director, Group Medicare Performance Optimization

About the position Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. At Aetna, we are committed to helping our members achieve their best health in an affordable, convenient and comprehensive manner. Group Retiree Solutions (GRS) is a core component of the Aetna Medicare Organization. Our vision is to develop an industry-leading group retiree health care business by delivering unrivaled value to our plan sponsors and members alike. We aspire to provide personalized, member-centric care that treats retirees like human beings during a sensitive chapter in their lives. We work as a strategic partner that is uniquely committed to helping our clients reach their benefit goals. Imagination, innovation, accountability and teamwork, with an emphasis on structure and process, drive us to deliver unparalleled results. We are seeking an Executive Director to lead the newly formed Group Medicare Performance Optimization team. This leader will preside over performance management from financial, operational and administrative perspectives. This leader will develop and oversee models to manage medical and pharmacy costs, identify patterns and trends while working collaboratively with business partners to drive performance improvements. This leader will also provide recommendations on the business levers necessary to pull in order to maximize competitiveness, growth and enterprise value in both the short and long-term.

Responsibilities

• Develop annual operating plans and work across the Aetna and Medicare organizations to assess performance, define clear program strategies and SAIs, establish outcome goals as well as measure and report on performance results for GRS' Top 15 clients.

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• Design conceptual models and strategies for interdependent, cross-functional projects and initiatives to deliver holistic solutions.

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• Collaborate with Medicare finance, actuarial and COE partners to identify areas where business performance is not running according to plan and develop remediation plans which can be executed and tracked.

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• Work closely with the Group Medicare CFO, as well as underwriting and actuarial leaders, to understand margin and revenue assumptions, assess how clients are performing relative to assumptions and / or forecasts, identify performance gaps and build actionable recommendations to enhance and / or maintain profitability.

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• Analyze Group Medicare business performance, profitability and trends to identify and lead business performance improvement opportunities, establish actionable insights and formulate strategies which bolster overall business efficiency, align with financial targets, etc.

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• Design reporting frameworks and dashboards to monitor, measure and socialize comprehensive performance results.

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• Develop and maintain a deep understanding of business impacts, internal initiatives and metrics driving business performance.

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• Analyze and report on market intelligence factors such as industry performance trends, best practices, competitive landscapes and relevant regulatory impacts in order to identify drivers for future success.

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• Communicate efficiently and effectively to translate novel strategies to audiences, including senior leadership.

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• Serve as the primary point of contact for the Medicare COE and other departments to prepare and report on ongoing business performance results, activities and initiatives.

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• Lead the Group Medicare governance forum to communicate results, elevate issues or barriers to success and ensure stakeholder alignment.

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• Oversee a team which collaborates closely with and functions as a direct extension of the GRS Account Management team.

Requirements

• 10+ years' of FP&A experience within the healthcare industry

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• Strong knowledge of Medicare; knowledge of Group Medicare Advantage will be highly valued

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• Strong understanding of CMS regulations such as the Inflation Reduction Act (IRA), Medicare Prescription Payment Plan (M3P) as well as Indirect Medical Education (IME) Payment and their financial impacts to the Medicare Advantage program

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• Strong financial acumen with deep experience conceptualizing new financial models, monitoring and optimizing business performance as well as setting strategic direction to achieve budget goals and financial targets

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• Advanced proficiency in Excel, Access, Tableau and / or other data reporting software will be highly valued

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• Demonstrated experience developing analyses, presentations and support material to successfully implement strategy or change initiatives

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• Ability to engage with business leaders at all levels independently and with high credibility

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• Strategic thinker with an ability to influence and to be innovative and resourceful in developing solutions

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• Proven ability to solve complex issues and manage multifaceted business relationships

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• Adept at building consensus with stakeholders with regards to strategy / direction, execution and delivery

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• High degree of comfort and fluency in flexing between strategic, big-picture thinking and tactical, detail-orientation execution

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• Strong mastery of problem solving, teamwork and collaboration

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• Highly motivated self-starter with a growth mindset

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• Confidence and courage to work independently, execute priorities, identify and initiate improvements without requiring step-by-step direction

Nice-to-haves

• Advanced Degree will be valued

Benefits

• Store discount

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• Employee stock purchase plan

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• Paid holidays

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• Disability insurance

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• Health insurance

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• Dental insurance

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• 401(k)

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• Tuition reimbursement

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• Paid time off

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• Vision insurance

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• Life insurance

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