Senior Director, Medicaid Value-Based Network Performance

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

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Equity award program

Job summary

CVS Health is seeking a senior leader to oversee Medicaid value-based care relationships across the Central Region, aligning contracts with quality and cost goals while reducing risk. The role includes supervising the Provider Performance team and coordinating with clinical, pharmacy, and financial experts.

The ideal candidate brings a decade in health plans or provider groups, strong Medicaid knowledge, and proven matrix management experience to drive payment models, performance, and strategic

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
• Identifies improvement opportunities. Provides strategy consultation on actions/tactics to make needed improvements
• 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

Leadership

Stakeholder engagement

Matrix management

Problem solving

Communication skills

Healthcare knowledge

Medicaid understanding

Client relationships

Education

Bachelor's degree preferred

Job description

CVS Health is seeking a senior leader to oversee Medicaid value-based care relationships across the Central Region, aligning contracts with quality and cost goals while reducing risk. The role includes supervising the Provider Performance team and coordinating with clinical, pharmacy, and financial experts.

The ideal candidate brings a decade in health plans or provider groups, strong Medicaid knowledge, and proven matrix management experience to drive payment models, performance, and strategic