Director, Managed Care Operations

Job not on LinkedIn

🔥 0 minutes ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $100k - $231.5k / year

⏰ Full Time

🔴 Lead

⚙️ Operations

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

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 Oak Street Health’s partnerships with national and regional Medicare Advantage health plans • Lead health plan relationships, strategy, contract negotiations and implementation, and ongoing operations and performance • Advance Oak Street Health’s value-based care model through strong, collaborative, and sustainable health plan relationships • Identify opportunities to demonstrate Oak Street Health’s value • Negotiate and manage complex value-based contracts • Resolve operational issues with urgency and accountability • Partner with executives and clinical, finance, data, population health, membership, engagement, legal, and field leaders • Craft payer strategy and drive successful contract negotiations and implementations • Monitor contract performance and communicate strengths, risks, and opportunities to senior leadership • Continuously improve workflows • Lead and develop team members • Represent Oak Street Health internally and externally with executive presence

🎯 Requirements

• 5-6+ years of experience managing Medicare Advantage payer relationships and leading full-risk contracting and operations at a value-based primary care organization • Proven success leading contract strategy and negotiating and managing value-based contracts • Mastery of key financial and operational terms and provider incentive design • Exceptional financial and analytical acumen • Experience evaluating contract economics, monitoring performance, and performing root-cause analysis • Complete understanding of value-based primary care and Medicare Advantage operations, including Stars performance optimization and membership attribution • Existing relationships with network contracting leaders at national and regional Medicare Advantage health plans • Deep experience with payer-provider data-sharing frameworks, provider roster management and credentialing processes, contract management systems, and reporting tools • Exceptional communication, facilitation, and stakeholder management skills, with executive presence • Outstanding project management skills and ability to independently drive complex initiatives to resolution • Ability to manage multiple priorities with strong attention to detail and sound business judgment • Mastery of Microsoft Excel, Word, PowerPoint, and similar tools • Ability to travel for occasional in-person payer and team meetings • Proven people leadership experience, including managing, developing, and mentoring associates within matrixed and rapidly evolving organizations • U.S. work authorization • Demonstrated alignment with “Oaky” values

🏖️ Benefits

• Paid vacation and sick time • Investment/retirement 401K match options • Health insurance, vision, and dental benefits • Leadership development opportunities • Continuing education stipends • Flexible work environments • Opportunities for high levels of responsibility and rapid advancement • Medical, dental, and vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being