Manager, Managed Care Directed Payments

Job not on LinkedIn

🔥 18 hours ago

🌪️ Oklahoma – Remote

🌪️ Oklahoma – Remote

💵 $54.3k - $119.3k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

Healthcare Insurance • Retail • Wellness

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Lead the development, execution, and optimization of Directed Payment Programs (DPPs) • Ensure compliance with SoonerSelect and OHCA regulatory and reporting requirements • Partner cross-functionally with Claims, Finance, Compliance, and other internal teams to ensure accurate payment processing • Act as the primary point of contact for providers, addressing complex payment issues and strengthening engagement • Monitor program performance, identify risks, and implement process improvements • Interpret regulatory guidance and translate requirements into actionable operational processes • Support audits, reporting, and documentation related to directed payment programs • Provide leadership across cross-functional initiatives, driving alignment and outcomes

🎯 Requirements

• 5+ years of healthcare experience, with a strong background in claims operations • Demonstrated experience partnering directly with healthcare providers to resolve complex issues • Solid understanding of Medicaid managed care, payment methodologies, and regulatory frameworks • Proven leadership skills with the ability to manage cross-functional initiatives and stakeholders • Bachelor’s degree in healthcare administration, Business, Finance, or related field (or equivalent experience)

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • other resources, based on eligibility