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, Clinical Business Operations who is responsible for developing Medical Policy & Program Solutions (MPPS) through executing short and long term strategic and operational objectives across Commercial, Medicare and Medicaid lines of business.  The role is also accountable for achieving financial and performance targets as well Commercial/Medicare/Medicaid Scoreable Action Item (SAI) Management.  Performance is measured against financial goals which include revenue, established SAI targets and ROI.

You'll make an impact by:

• Leading the strategy and drive operational efficiencies across Commercial, Medicare and Medicaid lines of business through programs that demonstrate significant cost savings for the enterprise.

• Managing the primary relationship with key vendors and is actively involved in the contractual process ensuring that contract guidelines are met and managed appropriately.

• Leading and executing the short and long term strategic and operational objectives for Commercial, Medicare and Medicaid lines of business - including achieving financial and performance targets.

• Collaborating with executive leadership throughout CVS/Aetna and serves as the primary “face” of the business when meeting with key vendors to drive specific programs through contractual arrangements.

• Responsibility for achieving cost savings through successful SAI implementation and management.

• Developing and maintaining collaborative relationships with internal and external partners/customers/vendors; works to establish collaborative relationships by fostering excellent customer response and appropriate problem resolution.

• Leading a team that promotes high standards of operational practice through advancement of policies, procedures, practice guidelines and alignment of clinical and non-clinical business processes and practices.

• Leading, implementing, monitoring, and trending operational process and workflows by encouraging the use of industry best practices and standards as well as developing new processes that improve outcomes.

• Leading recruitment and operating model development to meet business needs.

• Developing and/or overseeing the implementation of staffing models that are consistent, cost effective and meet all compliance obligations.

• Leading, developing, motivating, recognizing, and managing high-performing teams to meet organizational goals and objectives while effectively managing change.

• Building an environment that supports professional development, mobility, and operational excellence.

• Fostering a culture that accelerates our strategy through our Heart At Work Behaviors by keeping the customer and colleague as the central focus.

• 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.

• 15+ years of experience leading complex teams with knowledge of the healthcare system including medical management, claims, and provider networks.

• Strong interpersonal and communication skills, effectively communicate key messages to executive leaders and internal/external stake holders.

• Strong business and financial acumen.

• Must have strong financial and operational expertise with a history of achieving results.

• Ability to operationalize external vendor solutions to complex operational issues.

• Established ability to develop innovative operational changes.

• Demonstrate executive presence and ability to interact with internal and external constituents.

• Ability to work a hybrid model (in office Tuesday / Wednesday / Thursday) in a nearby office or a remote work arrangement if not located near an office.

• Ability to travel up to 20%.

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

Education
Bachelor's degree required.

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. 
 
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 Benefits | CVS Health

We anticipate the application window for this opening will close on: 10/31/2024

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