Director, Medicaid Value-Based Care & Provider Performance

CVS Health; Indiana (PA); Hybrid; USD 100,000 - 232,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Job summary

CVS Health is seeking a senior leader to oversee Medicaid value-based contracting and provider performance across the Central Region. You will lead a team focused on complex, high-value provider relationships and ensure contract terms drive quality while reducing costs.

Responsibilities include strategy development, performance management, and cross-functional collaboration with clinical, financial, and analytics partners to optimize outcomes.

Qualifications

• 10+ years experience in a health plan, health system or provider organization, ACO / managed-care experience preferred.
• Strong understanding of Medicaid products, provider engagement, and regulatory compliance requirements.
• Experience directly managing people and/or teams
• Self-directed individual with independent problem-solving skills
• Proven ability to interact with, influence and collaborate with internal and external stakeholders at all levels
• Experience managing matrixed environment with ability to leverage internal business partners to complete tasks
• Good interpersonal and communication skills
• Knowledge of healthcare and insurance industry
• Ability to form strong client relationships

Responsibilities

• Provider Relationship Management - Understands the terms of the value based contract arrangements to answer questions/address issues.
• Educates internal and external parties as needed to ensure compliance with contract terms and expectations
• Coordinates and prepares for external provider meetings and ensures that the most impactful internal subject matter experts are utilized to optimize performance.
• Assists with workflow development and strategies to integrate data and reporting
• Works independently to manage relationships and identify/implement solutions to problems
• Drives provider performance and partners with local market to ensure pathways to performance against business and team objectives
• Drives improvement in deal performance for multiple lines of business, complex models, and/or advanced national provider partners
• Leverages reporting/data to monitor contract performance against financial, clinical, cost and efficiency targets
• Assumes supervisory responsibilities for VBS Provider Performance team members Identifies improvement opportunities
• Assists Executive Director, Provider Performance, in developing and driving strategies to achieve organizational goals
• Serves as support and back-up to Executive Director, Provider Performance, as needed
• Drives and monitors consistency and adherence to policies/protocols of department
• Assists in identification and promotion of best practices within Team
• Identifies training and/or educational needs within Team
• Oversees training plan for new Team colleagues

Skills

Health plan experience

Medicaid knowledge

People management

Independent problem solving

Stakeholder collaboration

Matrixed environment

Interpersonal skills

Healthcare industry knowledge

Client relationship building

Education

Bachelor's degree preferred

Job description

CVS Health is seeking a senior leader to oversee Medicaid value-based contracting and provider performance across the Central Region. You will lead a team focused on complex, high-value provider relationships and ensure contract terms drive quality while reducing costs.

Responsibilities include strategy development, performance management, and cross-functional collaboration with clinical, financial, and analytics partners to optimize outcomes.