Job Description Fully accountable leader, charged with managing sustainable Individual Exchange P&L, market performance, delivering growth and managing costs in alignment with strategy and operating plan goals
Responsible for achieving target market position, overall financial performance of Individual Exchange plans within the Market, and local execution of Risk Adjustment, compliance, and revenue yield in collaboration with corporate teams
Drives local product strategy, local market intelligence, and cost structure reduction (SAIs) in collaboration with Individual COE leadership, the market president(s) and related teams
Responsible for managing cost structure, HEDIS, and Revenue Integrity efforts
Influences Individual sales, operations, contracts, provider relations, network development, utilization management, quality improvement and coordinates and monitors functional integration of these areas in cooperation with corporate departments to achieve planned business results
Directs all departments and teams in the development, implementation and maintenance of policies and procedures to ensure compliance with State and Federal regulatory requirements
Responsible for the plan performance related to all required Federal audits
Monitors budget in assigned function areas and takes corrective action
Coaches, mentors, and manages performance of team members; drives talent development and actively builds bench. Creates a customer focused culture and collaborates across the organization to ensure internal and external constituent needs are met
Serves as Ambassador for increasing Individual Exchange market knowledge
Promotes cultural awareness and sensitivity matching needs of communities served or key roles
Required Qualifications Knowledge of insurance regulatory and contractual requirements
3-5 years of solid Individual Exchange experience
7-10 years of experience in Business Development, direct sales or Client Management Leadership
Ability to develop and execute strategy
P&L expertise and strong financial, bottom-line focus
Strong affinity understanding of target audiences, needs and sales management
Strong facilitative leadership and business problem solving skills
Ability to effectively interact with a diverse workforce and cross functional groups
Ability to deal effectively with multiple internal and external clients
Knowledge of value-based agreements
COVID Requirements COVID-19 Vaccination Requirement CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.
If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 10 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 45 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 10 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.
Preferred Qualifications Deep knowledge of local markets in the State of North Carolina
Work location: North Carolina
Experience working in a matrixed environment
Previous experience working for a large, national carrier
Education Bachelor's Degree required.
Master's Degree preferred
Business Overview At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
Internal Number: 1886312BR
About CVS Health
Combining CVS Health and Aetna was a transformative moment for our company and our industry, establishing CVS Health as the nation’s premier health innovation company. Through our health services, insurance plans and community pharmacists, we’re pioneering a bold new approach to total health. As a CVS Health colleague, you’ll be at the center of it all.
At CVS Health, we work every day to help people on their path to better health. Never has it been more important for us to deliver on our purpose to our valued customers, patients, members, and employees. With a presence in communities across the country, CVS Health colleagues are and will continue to be a critical piece of the country’s health care solution. The health and safety of our employees, patients, customers, and members is our top priority as we face the impact of COVID-19 together. If you would like to learn about the actions we are taking as a company as we learn more about COVID-19 and its spread, we encourage you to visit our COVID-19 resource center at https://cvshealth.com/covid-19
We offer a diverse work experience that empowers colleagues for career success. In addition to skill and experience, we also seek to... attract and retain colleagues whose beliefs and behaviors are in alignment with our core values of collaboration, innovation, caring, integrity and accountability.
CVS Health is an equal opportunity/affirmative action employer. Gender/Ethnicity/Disability/Protected Veteran – we highly value and are committed to all forms of diversity in the workplace. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT. Please note that we only accept applications for employment via this site.
We provide reasonable accommodations to qualified individuals with disabilities. If you need to request an accommodation, a qualified interpreter, written information in other formats, translation or other services, please contact our Advice and Counsel Reasonable Accommodations team by emailing Advice and Counsel Reasonable Accommodations team or calling 877-805-9511.
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