Lead Director – Performance Analytics, Optimization

Job not on LinkedIn

🔥 15 hours ago

🏈 Alabama, Arizona, +19 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⚔️ Virginia – Remote

💵 $100k - $231.5k / year

⏰ Full Time

🟠 Senior

👔 Director

👻 Ghost score 0%

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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

• Establish and maintain a standardized performance measurement framework across Payment Integrity editing platforms • Monitor edit performance throughout the edit lifecycle • Develop and maintain KPIs, performance scorecards, Power BI dashboards, and executive reporting • Analyze trends in claims, savings, utilization, provider behavior, and edit outcomes • Identify underperforming, overperforming, anomalous, inaccurate, or high false-positive edits • Establish performance thresholds, quality standards, sampling methodologies, and monitoring practices • Provide executive-level reporting and insights to Payment Integrity leadership • Independently measure and validate edit savings • Monitor expected versus realized savings and identify financial performance variance • Partner with Finance and Payment Integrity leadership on savings methodologies • Identify opportunities to improve savings realization through optimization • Provide objective feedback to editing and solution design teams • Partner with editing teams on optimization strategies • Balance financial opportunity with edit accuracy, provider experience, and operational efficiency • Establish and manage continuous optimization and post-deployment review processes • Develop data-driven optimization recommendations and prioritize activities based on financial impact, quality, risk, and operational value • Track recommendations through completion and measure resulting impact • Oversee centralized performance reporting for Payment Integrity editing

🎯 Requirements

• 5+ years of progressive experience in healthcare, Payment Integrity, claims, analytics, data, operations, or a related field • 5+ years of leadership experience managing teams and/or complex enterprise programs • Demonstrated experience leading analytics-driven performance management • Experience working with large, complex datasets and translating data into business decisions • Experience developing executive dashboards and performance reporting • Experience with healthcare claims data and payment integrity strongly preferred • Experience with claims editing, prepay/post-pay processes, or claims platforms strongly preferred • Demonstrated experience with continuous improvement and optimization methodologies • Bachelor’s degree in Business, Analytics, Data Science, Healthcare Administration, Finance, Information Systems, or related work experience required

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program • Award target in the company’s equity award program • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being