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.

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, Quality Strategy & Initiatives who is accountable for the achievement of quality performance and leadership of Aetna’s quality government programs (Medicare, Medicaid, IFP, Duals). This leader will focus on HEDIS Hybrid, STARS, Performance Improvement Plans, provider & member enablement, regulatory and accreditation compliance. This individual will lead a cross-functional team consisting of approximately 500 clinical and non-clinical staff. Collaboration with shared service partners is essential to achieve our goals. This includes, but not limited to, network, contracting, member service, and business leaders across the enterprise with a membership in Medicare and Duals at 4.2M, and Medicaid at 2.4M.

You’ll make an impact by:

• Developing and driving business competitive market leading approaches with accurate interpretation of product line related specifications, methodologies, and processes to improve results. (HEDIS, Performance Improvement Plans, CAHPS, STARS and Performance Incentive dollars)

• Fostering and leading through a complex, matrixed enterprise structure to collaboratively promote Aetna Government Quality Improvement Program and Accreditation.

• Leading a strong business performance, ensuring all Quality Incentive Award (QIA), STAR performance objectives including P4P targets, growth, retention, and STAR ratings are achieved.

• Defining and regulating a preparedness and compliance culture and discipline with federal and state laws and regulations related to quality improvement program; proactively identifies risk and remediation strategies.

• NCQA focus on all lines of business on health plan accreditation, long-term support services distinctions, medication adherence module and health equity.

• 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 experience in healthcare/managed care leadership roles with experience in HEDIS/Medicaid/Medicare/Duals/IFP Quality program performance management, analytics, reporting and forecasting with a regional and national scale.

• Proven experience driving performance management and meeting/exceeding state, federal contract requirements and operational performance.

• Experience with achieving STAR rating targets greater than industry average.

• Strong understanding of state/federal quality requirements and key strategic and operational imperatives/interoperability (data ingestion).

• Strong problem solving and analytical skills.

• Ability to build, cultivate, and support teams with excellent leadership skills and the ability to influence line management decisions with data driven facts. Ability to work collaboratively within a matrix organization as well as influence with and without formal authority to drive performance outcomes.

• Maintain intelligence on competitor capabilities, technology, and overall competitive advantage.

• Exemplary collaboration across large, matrixed organization stakeholders.

• Logic and data-driven approach coupled with an elevated level of emotional intelligence, intellectual curiosity, and root cause analysis to drive insights and solutions.

• Proven experience inspiring and developing a highly focused, cohesive team of professionals accountable for improving health outcomes and enabling market leading performance.

• Strong change leadership, facilitation, oral and written communication, and presentation skills.

• Ability to work a Hybrid Model (in office Tuesday/Wednesday/Thursday) out of a local Aetna Hub location.

• Demonstrate a commitment to diversity, equity, and inclusion through continuous development, modeling inclusive behaviors, and proactively managing bias.

Preferred Qualifications

• Clinician preferred (MSW or RN licensure)

Education

• Bachelor’s Degree required.

Pay Range

The typical pay range for this role is:

$157,800.00 - $363,900.00

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. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. 
 
For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 09/30/2024

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