Director, Medicaid Value-Based Network Management

CVS Health; Iowa (LA); Hybrid; USD 100,000 - 232,000; Full time

Benefits offered by this job

Equity program

Bonus eligibility

Benefits package

Job summary

CVS Health in the United States seeks a senior leader to align and oversee Medicaid value-based contracts across the Central Region, guiding high-value provider relationships and performance initiatives. You will supervise the VBS Provider Performance team, shape strategies, and ensure contracts deliver quality care while reducing costs.

The ideal candidate has 10+ years in health plans or provider organizations, strong Medicaid knowledge, and proven stakeholder collaboration skills to drive

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. Responsible for establishing and maintaining productive, professional relationships.
• 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.
• Provides strategy consultation on actions/tactics to make needed improvements
• 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 communication

Healthcare/insurance knowledge

Client relationship skills

Education

Bachelor's degree

Job description

CVS Health in the United States seeks a senior leader to align and oversee Medicaid value-based contracts across the Central Region, guiding high-value provider relationships and performance initiatives. You will supervise the VBS Provider Performance team, shape strategies, and ensure contracts deliver quality care while reducing costs.

The ideal candidate has 10+ years in health plans or provider organizations, strong Medicaid knowledge, and proven stakeholder collaboration skills to drive