Medicaid Value-Based Network Director, Provider Performance

CVS Health; United States; Remote; USD 100,000 - 232,000; Full time

Benefits offered by this job

Bonus eligibility

Equity awards

Comprehensive benefits

Job summary

CVS Health seeks a senior leader to oversee Medicaid value-based contracting and provider performance within the Central Region. You will align terms with quality goals, manage strategic provider relationships, and steer the VBS Provider Performance team toward improved outcomes.

You will partner with cross-functional teams to drive cost reductions while maintaining care quality and ensuring policy adherence. This full-time role emphasizes strategic oversight and stakeholder collaboration.

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 and identifies improvement opportunities
• 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

Skills

Health plan experience

Provider engagement

People management

Independent problem-solving

Stakeholder collaboration

Matrixed environment

Communication skills

Healthcare knowledge

Client relationships

Education

Bachelor's degree preferred

Job description

CVS Health seeks a senior leader to oversee Medicaid value-based contracting and provider performance within the Central Region. You will align terms with quality goals, manage strategic provider relationships, and steer the VBS Provider Performance team toward improved outcomes.

You will partner with cross-functional teams to drive cost reductions while maintaining care quality and ensuring policy adherence. This full-time role emphasizes strategic oversight and stakeholder collaboration.