Hybrid Health Plan Operations Lead

CVS Health; Hartford (CT); Híbrido; USD 75.000 - 199.000; Jornada completa

Descripción de la vacante

CVS Health in Hartford, CT is seeking an Operations Lead for the DUAL Program Management to oversee day-to-day health plan operations and ensure regulatory readiness. You will coordinate with market leadership, enterprise partners, and shared services to drive operational excellence and timely member outcomes.

Responsibilities include developing readiness workplans, monitoring performance, and guiding issue resolution across claims, enrollment, member services, care management, and compliance.

Formación

• 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 and state regulatory requirements.
• Experience developing executive-level reports, presentations, and dashboards.
• Demonstrated ability to influence stakeholders and drive issue resolution without direct authority.
• Experience leading operational readiness, implementation, or transformation initiatives.
• Excellent verbal, written, and presentation communication skills.
• Advanced proficiency in Microsoft Excel and PowerPoint.

Responsabilidades

• 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, benefit changes, regulatory requirements, and market expansions.
• Monitor operational performance, service levels, regulatory requirements, and business outcomes; escalate risks and develop remediation strategies.
• Develop and maintain operational workplans, readiness trackers, risk logs, and reporting tools for leadership visibility.
• Drive issue management, facilitating cross-functional discussions to identify root causes and implement corrective actions.
• Coordinate with enterprise shared services (claims, enrollment, member services, care management, provider services, compliance) for seamless execution.
• Support CMS/state audits and regulatory reporting through documentation and remediation planning.

Conocimientos

Healthcare operations

Cross-functional leadership

Stakeholder influence

Regulatory compliance

Data analysis

Microsoft Excel

Microsoft PowerPoint

Verbal and written communication

Problem solving

Educación

Bachelor's degree in Business Administration or Healthcare Administration or related field

Herramientas

Microsoft Excel

Microsoft PowerPoint

Data analysis tools

Descripción del empleo

CVS Health in Hartford, CT is seeking an Operations Lead for the DUAL Program Management to oversee day-to-day health plan operations and ensure regulatory readiness. You will coordinate with market leadership, enterprise partners, and shared services to drive operational excellence and timely member outcomes.

Responsibilities include developing readiness workplans, monitoring performance, and guiding issue resolution across claims, enrollment, member services, care management, and compliance.