Lead Director, Medicaid VBC & Provider Performance

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

Benefits offered by this job

Comprehensive benefits package

Bonus eligibility

Job summary

CVS Health is seeking a leader to align and manage Medicaid value-based contracts across the Central Region, overseeing provider performance strategies and collaboration with clinical, financial, and analytical teams.

The role requires a decade of health-plan or provider-network experience, strong stakeholder management, and the ability to drive deal performance while guiding a VBS Provider Performance team.

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.
• 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.

Education

Bachelor's degree preferred

Job description

CVS Health is seeking a leader to align and manage Medicaid value-based contracts across the Central Region, overseeing provider performance strategies and collaboration with clinical, financial, and analytical teams.

The role requires a decade of health-plan or provider-network experience, strong stakeholder management, and the ability to drive deal performance while guiding a VBS Provider Performance team.