Operations Lead — Dual-Eligible Health Plan Programs

CVS Health Corporation; Hartford (CT); On-site; USD 75,000 - 199,000; Full time

Job summary

CVS Health Corporation in Hartford, CT is seeking an Operations Lead to oversee day-to-day health plan operations, ensure regulatory readiness, and drive strategic initiatives across Integrated Plans. The role acts as the primary liaison among market leadership, enterprise partners, shared services, and regulators to achieve operational excellence and positive member outcomes.

You will develop workplans, readiness trackers, risk logs, and reporting tools; monitor performance and compliance; lead

Qualifications

• 7+ years of healthcare operations or related experience.
• 5+ years of experience leading cross-functional operational initiatives and driving organizational outcomes.
• Experience supporting D-SNP, FIDE, HIDE, MLTSS
• Strong knowledge of CMS, state regulatory requirements, health plan operations, and audit readiness processes.
• Experience developing executive-level reports, presentations, and operational performance dashboards.
• Demonstrated ability to influence stakeholders and drive issue resolution without direct authority.
• Experience leading operational readiness, implementation, or transformation initiatives.
• Strong analytical, problem-solving, and decision-making skills.
• Excellent verbal, written, and presentation communication skills.
• Advanced proficiency in Microsoft Excel, PowerPoint, and data analysis tools.
• Bachelor’s degree in Business Administration, Healthcare Administration, Public Health, Operations Management, or related field, or equivalent combination of education and experience.

Responsibilities

• Provide operational oversight 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, escalating risks and developing remediation strategies as needed.
• Develop and maintain operational workplans, readiness trackers, risk logs, and reporting tools to support leadership visibility and accountability.
• Drive issue management processes, facilitating cross-functional discussions to identify root causes, implement corrective actions, and prevent future operational impacts.
• Partner with enterprise shared services teams, including claims, enrollment, member services, care management, provider services, and compliance, to ensure seamless operational execution.
• Support state, CMS, NCQA, and internal audit activities through coordination of documentation, evidence collection, remediation planning, and progress reporting.
• Monitor regulatory changes and contract requirements to ensure timely operational implementation and ongoing compliance.
• Develop executive-level reporting and presentations that communicate operational performance, readiness status, risks, issues, and mitigation plans. Act as a trusted operational subject matter expert and primary point of contact for internal and stakeholders regarding Integrated Plan operations.
• Support financial remediation efforts by identifying operational drivers of financial performance and partnering with business owners to implement corrective actions. Maintain strong relationships with market leaders, executive leadership, enterprise partners, regulators, and community stakeholders to support business objectives and member outcomes. Provide operational leadership during critical incidents, readiness events, and regulatory escalations, coordinating action plans and ensuring timely resolution.
• Support additional Health Plan Market Operations activities and provide cross-functional support as business needs require.

Skills

Analytical thinking

Problem solving

Decision making

Verbal communication

Written communication

Presentation skills

Influence without authority

Cross-functional leadership

Leadership in initiatives

Education

Bachelor's degree in Business Administration, Healthcare Administration, Public Health, Operations Management, or related field

Tools

Microsoft Excel

PowerPoint

Data analysis tools

Job description

CVS Health Corporation in Hartford, CT is seeking an Operations Lead to oversee day-to-day health plan operations, ensure regulatory readiness, and drive strategic initiatives across Integrated Plans. The role acts as the primary liaison among market leadership, enterprise partners, shared services, and regulators to achieve operational excellence and positive member outcomes.

You will develop workplans, readiness trackers, risk logs, and reporting tools; monitor performance and compliance; lead