VP, Medicare & Duals Care Management

Job DescriptionThis is an exciting time to join CVS Health, as we accelerate upon our strategy to enhance health care delivery for our members across our suite of clinical program offerings and capabilities. Within the Medicare and Duals Care Management organization, we are supporting continued membership growth and are well positioned within the marketplace with a portfolio of strong products. We are seeking top leadership talent that brings their heart to work every day to join forces and create simplicity for our members. The VP of Medicare & Duals Care Management will support the organization led by the SVP of Clinical Services. This role is responsible for providing leadership and direction to over 2,000 clinical and non-clinical colleagues supporting over 3 million Medicare and Duals Special Needs Plans (DSNP) members. Leads day to day operations and manages a large operating budget to design, deliver and enhance a suite of holistic clinical engagement programs including field-based care management, disease education, gaps in care communication and dual eligible clinical programs.Key Responsibilities: Development, implementation and oversight of people, processes and technology required to engage with Aetna's Medicare Individual and Group members using a population health approach to targeted member engagement. Responsible for clinical program outcomes, interventions, compliance and financial value. Scaling, strategic enhancement and day to day operations of the Duals (including DSNP, FIDE SNP, CSNP and MMP enrollees) clinical operations including supporting significant growth in operations, clinical platform migration, compliance and operational enhancements to drive year over year cost efficiency improvements across 10+ local market plans. Active thought leadership and partnership across the full clinical strategy and model of care for the Medicare and DSNP segments, inclusive of CM and UM program design and driving innovation across the clinical functions to improve performance and member outcomes. Leads the integration of CVS assets for the benefit of Medicare & Duals member experience, inclusive of a high degree of interaction with Aetna Behavioral Health, KidneyCare, Oncology, Health Hub, Minute Clinic, and serves as a thought leader in the expansion of our home health engagement in light of expanding enterprise capabilities. Collaboration with the Government Lines of Business and Medical Affairs organization, as well as across the growing CVS Health portfolio of assets, to transform the health care experience for CVS customers and Medicare & Duals members. Oversight of chronic disease education and management programs for Medicare Group members, partnering with account teams in support of profitable business growth.REMOTE - working East Coast hoursRequired Qualifications 10-15 years leading large matrix clinical organizations Experience with Medicare or Duals products Strong people leadership skills Innovative operational leader with experience creating and leading successful program (e.g. Population Health programs) Analytical acumen Proven experience with financial budget planning Registered Nurse (RN) or similar clinical background strongly preferred Aligns with the values of CVS Health - Innovation, Collaboration, Caring, Integrity, Accountability.COVID RequirementsCOVID-19 Vaccination RequirementCVS 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.Preferred QualificationsSee aboveEducationBachelor's degreeRN, LCSW, or LMSW will be highly valuedBusiness OverviewBring your heart to CVS HealthEvery 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. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2025-11-15