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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

CVS Accountable Care, a CVS Healthspire business, is a strategic partner in value-based care serving more than 1M Medicare beneficiaries, and over 60K provider partners across 230 clients in ACO REACH, Medicare Shared Savings Program (MSSP), and Medicare Advantage programs. We are model-agnostic and payer-agnostic that is focused on providing the support needed to successfully enable providers as they progress from limited to full risk. With more than 10 years of value-based care experience, we have worked together with diverse partner types including Academic Medical Centers, Federally Qualified Health Centers, Clinically Integrated Networks, and Independent and Community-based Providers. Our flexible services are customized to support our partners' individual needs for success in value-based care including technology and analytics, clinical programs, practice transformation, and administrative support.

CVS Accountable Care is seeking an Executive Director, Payor Medical Economics to join our growing organization.  In this leadership role, this person is responsible for coordinating with business and finance teams to provide the necessary performance modeling, underwriting, and related financial performance across payor programs including MA, Commercial, Exchange and Medicaid, interface with senior leaders within CVS Accountable Care and the larger CVS enterprise to represent a coordinated view of key actuarial analyses, build out additional actuarial capabilities including MA and other health plan risk-based programs, and collaborate with our ACO actuarial team.  This leader will participate in negotiation with payors and represent CVS Accountable Care actuarial services to external prospects and provider partners, and lead collaboration and coordination with analytics, finance, strategy and product, business development, partner success, clinical and operations, and other relevant functional teams.  This leader is responsible for oversight of the organization’s risk structures through regular and systematic analysis and forecasting of financial/statistical data in a manner that is actuarially sound, competitive in the marketplace, and that provides income in accordance with organizational goals and objectives. 

You’ll make an impact by:

• Providing oversight and participating in the development of new payor models as needed for pricing, reserving, and medical cost/utilization trends under a variety of program requirements including value-based arrangements, MLR calculations, shared savings models for MA, commercial, exchanges and Medicaid populations.
• Participate in payor negotiations.
• Collaborating with the ACO Actuarial team to expand the overall actuarial services to drive business objectives.
• Coordinating between business, finance, and the greater CVS actuaries for review and assessments of key forecasting and performance analyses.
• Representing CVS Accountable Care actuarial services externally to prospects and provider partners.
• Assisting with model development for identifying and implementing clinically viable tools for provider behavior change.
• Proactively identifying pricing opportunities and risks (trend anomalies, outliers, behavior implications to specific structures).
• Providing oversight of comprehensive documented observations, analyses and interpretations of results including technical reports, summaries, and quantitative analyses.
• 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:

• ASA or FSA designation required.

• 10+ years of experience in the group health or related field with a deep knowledge of the health care actuarial and underwriting functions required.

• 5+ years of management experience required.

• Strong verbal, written and interpersonal communication skills.

• Ability to manage multiple tasks and deadlines.

• Ability to work in a team environment, working closely with our analytics department.

• Advanced Excel application design skills, with ability to pull/manipulate data using SQL.

• Ability to maintain a high degree of confidentiality.

• Ability to conceptualize new product services and new financial models.

• Possess an Executive Presence to present to internal and external customers.

• Ability to represent CVS at industry conferences.

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

Education
Bachelor’s degree or higher in mathematics, actuarial science, or closely related field; statistics background would prove helpful in this role.

Pay Range

The typical pay range for this role is:

$131,500.00 - $303,195.00

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.