CEO, Aetna Better Health of North Carolina

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

Aetna Better Health is Aetna’s Medicaid managed care plan. Backed by over 30 years of experience managing the care of those with a broad array of health care needs, our Medicaid plans have demonstrated that getting the right help when you need it is essential to better health. That’s why Aetna® Medicaid plans include the guidance and support needed to connect our members with the right coverage, resources, and care. We are focused on enhancing quality and population health outcomes while integrating CVS assets to bring accessible healthcare to our members.

The Chief Executive Officer has the responsibility for growing and leading the Medicaid business in North Carolina.  These responsibilities include leading all aspects of the plan including implementation of all contract requirements, ownership of profit and loss by meeting revenue projections, maintaining and growing membership, developing a high-performing network, and maintaining network adequacy.  This leader will ensure Quality benchmarks are met, articulating, and executing initiatives that drive member and provider satisfaction, and operating income plans. The CEO must ensure that the plan is following all state and federal requirements, statutory mandates and NCQA requirements.

The CEO must develop a strong local leadership team (CFO, COO, CMO, Community Development, and Contract Managers) and ensure the state customer has familiarity with and confidence in this team. The CEO must strive to establish themselves as a thought-leader and Aetna brand ambassador throughout the state, particularly through interactions with state agency leaders and community-based partners who serve the beneficiaries of Medicaid (TANF, LTC/LTSS, ABD) and CHIP programs.

You’ll make an impact by:

• Executing all market-specific state requirements through efficient programs and processes to meet or exceed all State contract expectations.

• Strategically drive successful results in a highly matrixed environment.  Executing innovative market-specific strategies to drive sustainable and profitable growth while setting the strategic direction to drive business growth.

• Possessing the state-specific knowledge and executive presence to command respect and establish a spirit of partnership in all regulatory interactions.

• Understanding the competitive landscape and state environment and translate that into business strategy. Collaborating closely with State Agency on strategies to improve and lead in market share across the statewide Medicaid footprint.

• Responsibility for building and maintaining trust and exceptional relationships with State, Aetna leadership and colleagues. State stakeholders include state legislators/regulators, Governor’s offices, Secretaries, and top community leaders. 

• Transformational leader who is inspirational and can communicate Aetna’s vision, so others follow.  Driving a purpose-driven culture of collaboration, talent development, transparency, and trust.

• Understanding the demographics, health, social risk, and cultural profiles of the beneficiaries served under the contract.

• Planning for upcoming RFP’s and lead the team with business development to be successful in winning business and having strong outcomes.

• Communicating state agency requirements to the Aetna organization for program implementations; coordinating with internal resources to implement contract requirements; communicating ongoing implementation progress with representatives of the State and regulatory agencies.

• Achieving and maintaining full understanding of the contract/requirements, programs, and policies, including service scope, special service features, and history of service issues.

• 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:

• 10+ years of progressive leadership experience in the healthcare industry, with a minimum of 5 years at a senior executive level within a Medicaid managed care environment.

• Demonstrated success in strategic planning, financial management, operations optimization, and regulatory compliance.  Experience with RFP bid responses and orals presentations will be highly valued.

• Exceptional communication, interpersonal, and negotiation skills, with the ability to build trust and consensus among diverse stakeholders.

• Thorough understanding of Medicaid managed care program, policies, and healthcare delivery systems.

• Commitment to promoting health equity, addressing social determinants of health, and improving the health and well-being of Medicaid beneficiaries.

• Strong knowledge of the State-specific political landscape including State budget issues, legislative leadership goals and areas of focus.

• Experience with all aspects of successful plan management is essential: Compliance and Regulatory Oversight, Member Experience, Provider Engagement Strategy, Member Advocacy/ Outreach/ Retention, Quality Management/Outcomes, Value Based Contracting, Population Health/Heath Equity/ SDOH, Network Development and overall Operational Execution. 

• Proven ability to understand business strategies, to set strategic direction and formulate/execute concise solutions to complex problems.

• Proven ability to work successfully within a matrix environment and influence internal stakeholders to achieve optimal results.

• Strong people management skills and proven experience leading teams through growth and change.

• Must be nimble and adaptable - embrace change, foster a learning culture, empower the team, and maintain a proactive and innovative mindset.

• Aligns with and promotes the values of CVS Health – Innovation, Collaboration, Caring, Integrity, Accountability.

• Ability to work Hybrid Model (in office Tuesday / Wednesday / Thursday) in our North Carolina office.  Must live in North Carolina or be willing to relocate to North Carolina.

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

Preferred Qualifications

A background of living in the state; connections with the North Carolina Department of Health and/or health system leadership and key provider group relationships.

Education

Bachelor's degree required; Master's degree preferred.

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

CVS Health requires certain colleagues 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, religious belief, or other legally recognized reasons that prevents them from being 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 or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through ColleagueRelations@CVSHealth.com If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.