Manager, Medicaid Provider Performance

CVS Health

Springfield (IL)

On-site

USD 66,000 - 146,000

Full time

8 days ago

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Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Other resources

Job summary

CVS Health in Illinois seeks a Manager of Medicaid Provider Performance to drive value-based care initiatives and optimize provider relationships. You will manage performance analytics, develop strategic initiatives, and provide data-driven insights to improve outcomes and cost efficiency.

The role emphasizes collaboration with data analytics teams, Medicaid stakeholders, and provider leadership to ensure compliant, evidence-based care delivery. 40-hour weeks, full-time, with CVS Health bonuses.

Qualifications

2-4 years of experience in healthcare operations, data analytics, administration, or a related role.
Proficient in translating complex performance information into clear, executive-ready materials.
Strong communication and interpersonal skills, with the ability to collaborate with internal and external stakeholders at all levels.
Detail-oriented, organized, and able to manage multiple projects simultaneously.
Familiarity with Medicaid reimbursement models, value-based care, and shared risk arrangements (preferred).

Responsibilities

Serve as trusted partner to strategic providers, resolving contract-related issues and delivering practical solutions.
Lead execution of operational processes that support value-based care objectives.
Analyze complex data and translate findings into actionable insights, including provider performance trends and cost drivers.
Monitor financial and clinical performance related to value-based care contracts, identifying opportunities for cost savings.
Create data-driven materials to present to internal and external stakeholders, translating performance trends into insights.
Coordinate meetings with provider leadership teams to review performance and opportunities for improvement.
Act as a liaison between data analytics teams and providers to enable effective use of reporting.
Identify areas to improve processes and efficiency, including through AI tools and automation.

Skills

Data analytics

Excel

SQL

Data visualization

AI solutions

Communication

Stakeholder management

Project management

Education

Bachelor’s degree or equivalent work experience

Tools

Data visualization software

AI tools

Job description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Aetna Better Health of Illinois is part of Aetna® and the CVS Health® family, one of our country’s leading health care organizations. We’ve been serving people who use Medicaid services for over 30 years; from kids, adults and seniors to people with disabilities or other serious health issues.

Our Manager of Medicaid Provider Performance is a vital role in advancing the organization’s value-based care (VBC) strategy for the Illinois Medicaid Market. This position is essential to developing and managing provider relationships that drive improved health outcomes, cost efficiency, and compliance with state and federal Medicaid obligations. Critical will be developing and implementing strategic initiatives to increase provider readiness from traditional fee-for-service models to value-based care models.

Key Responsibilities

Serve as trusted partner to strategic providers, resolving contract-related issues, conducting targeted research, and delivering practical solutions for ad hoc and ongoing needs.
Lead execution of operational processes that support value-based care objectives.
Analyze complex data and translate findings into actionable insights, including provider performance trends, utilization patterns, cost drivers, and priorities for improved outcomes.
Monitor financial and clinical performance related to value-based care contracts, identifying opportunities for cost savings and utilization improvement.
Create data-driven materials to present to internal and external stakeholders, translating performance trends into clear insights and opportunities for action.
Coordinate meetings with provider leadership teams to review performance, recommendations, and opportunities for improvement.
Act as a liaison between data analytics teams and providers to support effective use of and access to reporting and ensure providers obtain the intended value from data.
Identify areas to improve processes and efficiency, including through the use of AI tools and/or automation.

Required Qualifications

2-4 years of experience in healthcare operations, data analytics, administration, or a related role.
Skilled in using data management and analysis tools, such as Excel, SQL, data visualization software, and/or AI solutions, to identify trends, gaps, and improvement opportunities.
Proficient in translating complex performance information into clear, executive-ready materials.
Strong communication and interpersonal skills, with the ability to collaborate effectively with internal and external stakeholders at all levels.
Detail-oriented, organized, and able to manage multiple projects simultaneously.

Preferred Qualifications

Familiarity with Medicaid reimbursement models, value-based care, and shared risk arrangements.

Education

Bachelor’s degree or equivalent work experience

Anticipated Weekly Hours: 40

Time Type: Full time

Pay Range:

The Typical Pay Range For This Role Is $66,330.00 - $145,860.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Great Benefits For Great People

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families.