Vice President, Chief Medical Officer - Medicare

Job description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary The Vice President, Medicare Chief Medical Officer serves as the senior physician executive for Aetna's Medicare business, accountable for advancing the clinical strategy and performance of the Medicare book of business. The Medicare CMO helps define and execute the long-term vision for how Aetna delivers industry-leading care, experience, and value for Medicare members in a rapidly evolving healthcare landscape. This leader brings deep Medicare expertise and physician perspective to improve affordability, quality, Stars, risk performance, member experience, growth, and health outcomes, with particular focus on older adults, individuals with chronic and complex conditions, dual-eligible members, and special needs populations. The Medicare CMO leads through a highly collaborative operating model. In close partnership with the Medicare business, Aetna Clinical Solutions (ACS), High Value Care and Care Models, Network, Product, Operations, Analytics, Technology, and Finance, the Medicare CMO establishes Medicare-specific priorities, aligns capabilities, and drives measurable results. The role provides physician leadership while leveraging the distinct expertise and accountabilities of each partner. Success is achieved through shared accountability with ACS and enterprise partners, leveraging the complementary strengths of clinical strategy, care delivery, operations, analytics, and execution. A central mandate is to build and lead a best-in-class Medicare Medical Affairs team with an exceptional culture defined by clinical excellence, collaboration, accountability, innovation, and commitment to Medicare members. The aspiration is to create the most dynamic and highly regarded Medicare Medical Affairs team in the country. Key Responsibilities Busine and Clinical Performance Serve as the accountable physician executive for the clinical performance of the Medicare book of business, including affordability, quality, Stars, risk performance, member outcomes, growth, and member experience. Partner with the Medicare business and ACS to develop and execute a differentiated strategy grounded in the needs of older adults, members with chronic and complex conditions, dual-eligible members, and special needs populations. Identify and prioritize the highest-value opportunities to improve total cost of care, utilization, quality, growth, retention, and market differentiation. Advance integrated approaches to members' medical, behavioral, functional, pharmacy, and social needs, including care transitions, home- and community-based care, and caregiver support. Champion strategies and programs that advance Aetna's clinical North Star, including member engagement, access to high-quality care, frictionless experiences, and medical cost affordability. Establish clear performance expectations, monitor results, and mobilize partners to address emerging risks and opportunities. Collaborative Execution Serve as the physician executive leader for Medicare Medical Affairs in strategic partnership with Aetna Clinical Solutions, bringing together physician leadership, nursing expertise, operational excellence, analytics, and innovation to advance Medicare performance. Co-create priorities, measures of success, and execution plans with ACS and business partners, fostering alignment and accountability across the enterprise. Partner with High Value Care and ACS to shape Medicare priorities and leverage enterprise capabilities in the design, implementation, evaluation, and scaling of differentiated care models. Partner with the Network Chief Medical Officer, Network leadership, and ACS to improve provider performance, advance value-based care, and strengthen strategic provider relationships, including specialty and value-based care arrangements that deliver clinical and financial impact. Align Product, Benefits, Operations, Analytics, Technology, Digital, Medical Economics, and Finance around Medicare clinical and business objectives. Team and Culture Leadership Recruit, develop, and retain an outstanding and diverse team of leaders with deep Medicare and population health expertise. Foster a culture of influence, clinical rigor, collaboration, accountability, innovation, and enterprise thinking. Establish clear roles, operating rhythms, development opportunities, and standards of excellence across the Medicare Medical Affairs organization. Develop future clinical leaders and create a talent pipeline that strengthens both Medicare Medical Affairs and the broader enterprise. Create an environment in which physicians and clinical partners challenge conventional thinking, innovate responsibly, and do their best work on behalf of members. Innovation, Product, and External Leadership Serve as a senior clinical advisor for Medicare product strategy, benefit design, member engagement, and bid development. Shape Aetna's perspective on the future of Medicare delivery, influencing strategies related to aging in place, home-based care, value-based care, AI/technology-enabled care, and emerging healthcare models. Leverage analytics, AI, technology, and emerging data sources to accelerate innovation and improve decision-making, outcomes, affordability, and provider and member experience. Evaluate clinical programs, partnerships, and solutions based on measurable clinical, financial, and operational impact. Serve as a leading clinical ambassador for Aetna Medicare, engaging with plan sponsors, providers, health systems, policymakers, and strategic partners to articulate and advance Aetna's vision for Medicare. Represent Aetna and help shape broader industry dialogue on Medicare innovation, quality, value-based care, and care delivery transformation. Build credibility and alignment across internal and external stakeholders, serving as a trusted clinical leader and spokesperson for Aetna's Medicare business. Regulatory, Quality, and Governance Leadership Provide physician leadership in interactions with CMS and other regulatory bodies. Translate regulatory developments, quality programs, and market trends into actionable Medicare priorities. Support audit readiness, compliance, and governance while maintaining the highest standards of quality, integrity, and member protection. Ensure that clinical decisions and programs remain grounded in evidence, regulatory requirements, and the needs of Medicare members. Required Qualifications MD or DO with board certification and current or previously unrestricted medical licensure. Deep understanding of Medicare Advantage, including Stars, risk adjustment, medical cost drivers, provider performance, value-based care, and regulatory requirements. Significant senior physician executive leadership experience in Medicare Advantage, value-based care, provider organizations, integrated delivery systems, health plan operations, or similarly complex healthcare environments. Demonstrated success improving clinical outcomes, quality, affordability, utilization, risk performance, and population health. Experience building and developing high-performing physician or multidisciplinary clinical teams. Demonstrated ability to establish a clear vision, build alignment, lead through influence, and drive measurable results in complex, highly matrixed organizations. Preferred Qualifications Experience with dual-eligible, special needs, and medically or socially complex populations. Experience leading large-scale clinical transformation, care model, or population health initiatives. Experience applying analytics, AI, digital health, and technology to improve clinical and business performance. MBA, MPH, MPP, or comparable advanced management, public health, or policy training. Pay Range The typical pay range for this role is: $375,000 to $475,000 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. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments . We anticipate the application window for this opening will close on: 09/18/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.