AVP - Network Government Programs

At Aetna, a CVS Health company, we are committed to helping our members achieve their best health in an affordable, convenient, and comprehensive manner. By combining our health insurance products and services with CVS Health’s strong local presence and pharmacy benefits management capabilities, we partner with members on their path to better health while transforming the health care landscape.

Aetna is recruiting an Associate Vice President (AVP), Network Government Services to provide strategic and operational leadership for network performance, actuarial partnership, adequacy, and compliance across Medicare and Medicaid. This role leads a dedicated team and serves as a critical connector between network strategy, bid development, regulatory filings, and market execution.

Role Impact & First‑Year Success Measures

In this role, you will have a visible enterprise impact by:

• Establishing a high‑performing, integrated team model across Medicare network actuarial, Medicaid network actuarial, network adequacy, and Medicare network compliance.
• Ensuring continued success of our network adequacy analytics, documentation, and governance supporting Medicare and Medicaid bids, as well as Commercial regulatory filings.
• Improving consistency, transparency, and timeliness of network insights that inform provider strategy, policy decisions, and rate development.
• Reducing escalations and reactive remediation by proactively identifying network performance, adequacy, and compliance risks.

Key Responsibilities

Enterprise & Network Leadership

• Lead and develop a team responsible for government network actuarial support, adequacy, and compliance, fostering a culture of accountability, collaboration, and continuous improvement.
• Partner with government business leaders to support affordability, bid competitiveness, and where appropriate membership growth.
• Influence across a highly matrixed organization inclusive of network, actuarial, clinical, operations, regulatory, and line‑of‑business teams.

Actuarial Partnership & Network Strategy

• Medicare actuarial support:
  • Focus on network curation, provider‑specific financial impacts of policy and contracting decisions, and strategic bid guidance.
• Medicaid actuarial support:
  • Analyze cost and utilization outliers, support de‑novo market opportunities, and evaluate network competitiveness at the state and regional level.
• Ensure actuarial insights directly inform provider strategy, contracting priorities, and bid positioning.

Network Adequacy & Regulatory Filings

• Oversee network adequacy analysis and reporting for Medicare, Medicaid, and Commercial programs.
• Ensure adequacy outputs directly support Medicare and Medicaid bids, as well as required Commercial regulatory filings.
• Maintain strong governance over methodologies, documentation, and assumptions used in regulatory submissions.

Medicare Network Compliance

• Provide operational leadership for Medicare network compliance, including how networks are operationalized and maintained in accordance with state and federal requirements.
• Oversee compliance deliverables such as mental health parity, Medicare AEP readiness, network ID implementation and maintenance, and ongoing regulatory monitoring.
• Partner with regulatory, legal, and operations teams to anticipate and mitigate compliance risk.

Decision‑Making & Execution

• Translate complex, and at times conflicting, data into clear recommendations, balancing risk, opportunity, and regulatory obligations.
• Apply both divergent thinking to explore solutions and convergent thinking to drive decisions, execution, and outcomes.
• Demonstrate resilience and adaptability when strategies shift, while maintaining momentum and team engagement.

Required Qualifications

• 10+ years of experience in the health insurance industry.
• Direct experience with Medicare and Medicaid network development, management, and performance oversight.
• Demonstrated people leadership experience with responsibility for developing and managing teams.
• Proven experience operating in a highly matrixed environment with actuarial, network, operations, clinical, and government program leaders.
• Strong analytical, problem‑solving, and executive communication skills.

Preferred Qualifications

• Experience partnering closely with actuarial teams; actuarial exam progress or certification is a plus but not required.
• Experience supporting Medicare and Medicaid bids, regulatory filings, or rate development.
• Background in network adequacy analytics, compliance, or regulatory reporting.
• Demonstrated commitment to a growth mindset, including talent development, agility, and continuous learning.