AVP, General Manager - Medicare - NY/NJ at CVS Health

New York, New York, United States

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Not SpecifiedCompensation

Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Health InsuranceIndustries

Requirements

Proven team leadership experience - leadership skills to build high-performing teams, manage and develop talent, influence, and impact a broad set of stakeholders, engage, and inspire others, and lead by example
Ability to lead teams and drive performance in a dynamic and fast-paced environment
Experience directing senior leaders of specific functional areas (e.g., operations, sales, marketing, provider relations, network development, utilization management, STARS/HEDIS quality improvement, Revenue Integrity)
Experience leading and developing people, preferably leading managers

Responsibilities

Medicare market specific P&L accountability for IVL/DSNP products, supporting Sales and customer experience agendas, Go-To-Market planning, and acquisition cost
Leader for market performance, cost structure, and local execution of medical costs management, compliance, and revenue integrity for all Medicare Advantage products (including collaboration with Employer Group team for EGWP products)
Drive local product strategy, local market intelligence, target market position, market share growth, and cost structure reduction (SAIs) in collaboration with Medicare segment leadership, market medical teams, Network Management teams, and others
Support Medicare programs with short- and long-term profitability and growth of the health plan
Spearhead implementation of new contracts, programs, services, and preparation of bid and grant proposals
Overall financial performance and achievement of the budget for Medicare plans within the market
Coordinate and monitor functional integration of assigned areas (e.g., operations, sales, marketing, provider relations, network development, utilization management, STARS/HEDIS, Revenue Integrity) with corporate departments to achieve business results
Lead all departments in development, implementation, and maintenance of policies and procedures for State and Federal regulatory compliance
Responsibility for plan performance related to all required State and Federal audits
Management and organization of plan activities related to Medicare business at the health plan
Monitor budget in assigned functional areas and take corrective actions when necessary
Partner effectively within the team and across the organization to align strategic initiatives, elevate solutions to barriers, and make decisions at executive levels
Create and execute a sustainable, profitable-growth strategy

Skills

Medicare Advantage

P&L Management

Sales Strategy

Customer Experience

Go-To-Market

Medical Cost Management

Compliance

Revenue Integrity

Market Intelligence

Product Strategy

Network Management

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters

1963Year Founded

DEBTCompany Stage

Healthcare, Consumer GoodsIndustries

10,001+Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.

The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.

The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.

The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.

CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.

Increased consumer interest in wellness boosts demand for CVS's health-related products.

The trend towards value-based care aligns with CVS's integrated healthcare approach.

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