Executive Director, Medicaid Performance Management

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.

The Executive Director, Medicaid Performance Management is a senior segment leader responsible for driving performance improvement across Aetna's Medicaid portfolio. This role serves as a strategic partner to market and segment leadership, helping identify opportunities, prioritize interventions, establish governance, drive accountability, and measure realized impact across financial, operational, quality, clinical, and regulatory performance domains.

The Executive Director will work across multiple Medicaid health plans and partner closely with leaders in Finance, Medical Economics, Revenue Integrity, Payment Integrity, Quality, Care Management, Network, Product, Clinical, and Operations. The role requires the ability to translate complex performance data into actionable insights, lead cross-functional improvement initiatives, support market turnaround efforts, and ensure measurable outcomes are achieved.

This individual will function as both a strategic advisor and execution leader, bringing together disparate teams to solve enterprise performance challenges and accelerate results across the Medicaid business. The role aligns with the organization's mission to maximize performance across all Medicaid markets through opportunity identification, governance, accountability, execution support, and value realization.

Key Responsibilities

Enterprise Performance Leadership

• Lead performance management activities across assigned Medicaid markets and enterprise initiatives.

• Assess financial, operational, quality, clinical, and regulatory performance to identify risks, opportunities, and emerging trends.

• Develop performance assessments and recommendations for executive leadership.

• Establish and maintain performance monitoring frameworks, KPI scorecards, dashboards, and accountability processes.

• Support forecasting, trend analysis, and performance reviews to drive informed decision making.

• Serve as a trusted advisor to senior Medicaid leaders regarding enterprise and market performance.

Performance Improvement & Transformation

• Lead complex cross-functional initiatives focused on improving Medicaid financial and operational performance.

• Partner with enterprise/segment and market leaders to identify, prioritize, and implement high-impact improvement opportunities.

• Facilitate root-cause analyses and develop action plans for underperforming markets and strategic priorities.

• Drive execution of enterprise interventions and monitor progress against established goals.

• Measure, validate, and communicate realized business impact and value realization.

• Lead special projects, market turnaround efforts, and enterprise performance initiatives.

Market Partnership & Stakeholder Management

• Build strong relationships with Medicaid market CEOs, State Presidents, functional leaders, and enterprise partners.

• Support market operating reviews and executive performance discussions.

• Facilitate collaboration across Finance, Operations, Product, Quality, Clinical, Network, and Analytics teams.

• Identify barriers to execution and escalate issues requiring leadership action.

• Serve as a liaison between enterprise functions and markets to ensure alignment and accountability.

Governance & Executive Reporting

• Develop executive-level scorecards, dashboards, reports, and performance narratives.

• Establish governance structures that drive accountability and sustained performance improvement.

• Lead preparation of materials for executive reviews, operating committees, and senior leadership forums.

• Monitor actions, risks, dependencies, and outcomes across performance initiatives.

• Ensure consistent reporting methodologies and performance management standards across markets.

Strategic Planning & Value Creation

• Support development of enterprise Medicaid performance strategies and multi-year improvement roadmaps.

• Evaluate market opportunities, regulatory developments, competitive trends, and emerging risks.

• Partner with leadership to prioritize investments and initiatives based on business impact.

• Support the development and deployment of best practices across the Medicaid portfolio.

Required Qualifications

• 10+ years of experience in healthcare, managed care, consulting, strategy, finance, operations, performance management, or business transformation.

• 5+ years of experience leading complex cross-functional initiatives in a highly matrixed environment.

• Demonstrated experience driving measurable business results through performance improvement efforts.

• Strong understanding of healthcare operations, financial performance drivers, and enterprise performance management.

• Proven ability to influence senior leaders and drive alignment without direct authority.

• Advanced analytical, problem-solving, and strategic thinking skills.

• Exceptional communication, presentation, and executive facilitation capabilities.

• Experience synthesizing large amounts of information into actionable recommendations and executive-level communications.

• Ability to manage multiple priorities in a fast-paced and evolving environment.

Preferred Qualifications

• Medicaid managed care experience strongly preferred.

• Experience supporting multiple health plans, markets, or business units simultaneously.

• Background in enterprise performance management, operational excellence, business transformation, consulting, or strategy.

• Knowledge of key Medicaid performance levers including:

  • Revenue Integrity

  • Payment Integrity

  • Quality / HEDIS

  • Risk Adjustment

  • Care Management

  • Medical Cost Management

  • Value-Based Care

  • Network Performance

  • Affordability and Cost Strategy

• Experience working directly with senior executives and market leadership teams.

• MBA, MHA, MPH, or other advanced degree preferred.

• Lean Six Sigma, PMP, or equivalent performance improvement certification preferred.

Pay Range

The typical pay range for this role is:

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.

Additional details about available benefits are provided during the application process and on Benefits Moments.

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

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