When Tavenner, 62, was confirmed as the administrator of the Centers for Medicare and Medicaid Services in May, she was the first person endorsed by the Senate for the job in nearly seven years. Managing CMS, which oversees the health entitlements and most of the Affordable Care Act, has been politically tricky. But Tavenner managed to overcome the toxic politics of health reform to earn bipartisan support; she was confirmed by a 91-7 vote. In part, it's because she has credentials in both government and industry. A former practicing nurse, she was Virginia's health secretary and the president of a major hospital chain. She's not a policy intellectual like some of her predecessors, but her background affords her a good mix of experience in diplomacy and management, key skills in running the huge agency. "I could not have picked a more ideal career path," she says. "But I didn't pick it. It was just fortunate." The tasks before Tavenner are big ones: In the next few months, she needs to get insurance marketplaces off the ground in every state, oversee an expansion of Medicaid in about half the states, and help Medicare design and evaluate experiments in payment methodology. She's also responsible for keeping Medicare and Medicaid's core functions running smoothly. And in a constrained budget environment, that has meant "full-time management" of resources. Recent reports from the Government Accountability Office highlighted delays in launching the complex new programs, but Tavenner says she's certain CMS will be ready in time for health reform. "We are confident, although we understand the workload is huge and we've got a lot of training to do, and a lot of state-by-state education to do," she says. Tavenner, a Virginia native, holds bachelor's and master's degrees in nursing from Virginia Commonwealth University.