Health Plan Operations Leader: Regulatory & Readiness

CVS Health; Chicago (IL); On-site; USD 75,000 - 199,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health in Chicago, IL is seeking an Operations Lead to oversee day-to-day health plan operations, ensuring regulatory compliance, and driving strategic initiatives across Integrated Plans. The role requires strong leadership and coordination across market leadership, shared services, and regulators.

You will establish readiness processes for product launches and regulatory changes, monitor performance, manage risk, and drive issue resolution with enterprise partners.

Qualifications

• 7+ years of healthcare operations, managed care, health plan administration, regulatory compliance, or related experience.
• 5+ years of experience leading cross-functional operational initiatives and driving organizational outcomes.
• Experience supporting Dual Eligible Special Needs Plans (D-SNP), FIDE, HIDE, MLTSS.
• Strong knowledge of CMS, state regulatory requirements, health plan operations, and audit readiness processes.
• Experience developing executive-level reports, presentations, and operational performance dashboards.

Responsibilities

• Provide operational oversight and coordination across health plan functional areas to support efficient and compliant service delivery.
• Lead cross-functional efforts to identify, prioritize, and resolve operational issues affecting members, providers, regulators, and business partners.
• Establish and maintain operational readiness processes for annual implementation activities, including product launches and regulatory requirements.
• Monitor operational performance, service levels, regulatory requirements, and business outcomes, escalating risks and remediation plans.
• Develop and maintain operational workplans, readiness trackers, risk logs, and reporting tools for leadership visibility.

Skills

Cross-functional leadership

Regulatory compliance

Operational oversight

Problem solving

Data analysis

Executive communication

Education

Bachelor’s degree in Business Administration, Healthcare Administration, Public Health, Operations Management, or related field

Tools

Microsoft Excel

PowerPoint

Data analysis tools

Job description

CVS Health in Chicago, IL is seeking an Operations Lead to oversee day-to-day health plan operations, ensuring regulatory compliance, and driving strategic initiatives across Integrated Plans. The role requires strong leadership and coordination across market leadership, shared services, and regulators.

You will establish readiness processes for product launches and regulatory changes, monitor performance, manage risk, and drive issue resolution with enterprise partners.