Medicaid Network & Provider Performance Director

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

Job summary

CVS Health seeks a seasoned leader to manage strategic provider relationships and oversee Medicaid value-based initiatives. The role focuses on complex contracts, performance metrics, and cost containment while guiding a team of provider performance professionals.

You will drive collaboration across clinical, pharmacy, financial and analytics partners, ensuring compliance and optimal care outcomes in a large scale health plan environment.

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 requirements.
• Experience directly managing people and/or teams.
• Self-directed with independent problem‑solving skills.
• Proven ability to interact with, influence and collaborate with internal and external stakeholders at all levels.
• Experience in a matrixed environment with cross-functional partners.
• Good interpersonal and communication skills.
• Knowledge of healthcare and insurance industry.
• Ability to form strong client relationships.

Responsibilities

• Oversee provider relationships and ensure contract terms compliance.
• Lead Medicaid value-based contracting strategies across the Central Region.
• Supervise VBS Provider Performance team members.
• Leverage data reporting to monitor contract performance against financial and clinical targets.
• Drive performance improvements across multiple lines of business and complex models.

Skills

Leadership experience

Medicaid knowledge

People management

Independent problem-solving

Stakeholder collaboration

Matrixed environment

Interpersonal skills

Healthcare industry knowledge

Client relationship building

Education

Bachelor's degree preferred

Job description

CVS Health seeks a seasoned leader to manage strategic provider relationships and oversee Medicaid value-based initiatives. The role focuses on complex contracts, performance metrics, and cost containment while guiding a team of provider performance professionals.

You will drive collaboration across clinical, pharmacy, financial and analytics partners, ensuring compliance and optimal care outcomes in a large scale health plan environment.