Strategic Health Plan Operations Lead

CVS Health; New York (NY); On-site; USD 75,000 - 199,000; Full time

Job summary

CVS Health is seeking an Operations Lead for Health Plan Market Operations to oversee day-to-day health plan operations, ensuring readiness and regulatory compliance while driving strategic initiatives. You will coordinate with market leadership, enterprise partners, shared services, and regulators to ensure operational excellence and successful member outcomes.

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

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.

Responsibilities

• Provide operational oversight and coordination 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.

Skills

Excel

PowerPoint

Data analysis

Education

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

Tools

Data analysis tools

Job description

CVS Health is seeking an Operations Lead for Health Plan Market Operations to oversee day-to-day health plan operations, ensuring readiness and regulatory compliance while driving strategic initiatives. You will coordinate with market leadership, enterprise partners, shared services, and regulators to ensure operational excellence and successful member outcomes.

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