Operations Lead: Dual Plan Programs & Readiness

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

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings

Job summary

CVS Health Corporation is seeking an Operations Lead to oversee day-to-day health plan operations, ensure readiness and regulatory compliance, and drive strategic initiatives across Integrated Plans. You will serve as the primary liaison between market leadership, enterprise partners, and regulators to ensure operational excellence.

This role requires strong leadership, cross-functional collaboration, and ability to influence outcomes across multiple teams.

Qualifications

• 7+ years of healthcare operations, managed care, health plan administration, regulatory compliance, or related experience.
• 5+ years of experience leading cross-functional operational initiatives and driving organizational outcomes.
• Experience supporting Dual Eligible Special Needs Plans (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 functions 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 readiness processes for annual implementations, 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.
• Develop and maintain operational workplans, readiness trackers, risk logs, and reporting tools for leadership visibility.
• 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 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.
• 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 as needed.

Skills

Healthcare operations

Cross-functional leadership

Regulatory compliance

Executive reporting

Excel

PowerPoint

Data analysis

Education

Bachelor's degree in Healthcare Administration

Tools

Excel

PowerPoint

Job description

CVS Health Corporation is seeking an Operations Lead to oversee day-to-day health plan operations, ensure readiness and regulatory compliance, and drive strategic initiatives across Integrated Plans. You will serve as the primary liaison between market leadership, enterprise partners, and regulators to ensure operational excellence.

This role requires strong leadership, cross-functional collaboration, and ability to influence outcomes across multiple teams.