Director, Medicaid Value-Based Care & Provider Performance

CVS Health; Nebraska; Hybrid; USD 100,000 - 232,000; Full time

Job summary

CVS Health is seeking a senior leader to manage Medicaid value-based provider relationships across complex networks. The role focuses on contract performance, cost reductions and quality improvement, with supervisory responsibilities for the VBS Provider Performance team.

You will drive collaboration with clinical, pharmacy, financial and analytics experts, educate partners on contract terms, and coordinate strategic initiatives across multiple markets to improve outcomes and efficiency.

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

• Oversee provider relationship management and ensure productive relationships.
• Educate internal and external parties to ensure contract compliance.
• Coordinate external provider meetings and align experts to optimize performance.
• Develop and implement data reporting and workflow integration strategies.
• Supervise VBS Provider Performance team and identify improvement opportunities.
• Drive performance improvements for multiple lines of business and complex models.
• Monitor contract performance using financial, clinical, cost and efficiency targets.
• Support executive leadership in strategy development and execution.

Skills

Provider relationships

Leadership

Stakeholder engagement

Problem solving

Education

Bachelor's degree

Job description

CVS Health is seeking a senior leader to manage Medicaid value-based provider relationships across complex networks. The role focuses on contract performance, cost reductions and quality improvement, with supervisory responsibilities for the VBS Provider Performance team.

You will drive collaboration with clinical, pharmacy, financial and analytics experts, educate partners on contract terms, and coordinate strategic initiatives across multiple markets to improve outcomes and efficiency.