Senior Manager, Medicaid Provider Performance

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🔥 0 minutes ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $82.9k - $182.5k / year

⏰ Full Time

🟠 Senior

👔 Manager

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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

• Serve as the primary point of contact for strategic provider relationships and provide day-to-day support for contract-related needs • Perform market analyses to identify provider candidates for value-based contracts and initiate conversations with provider groups • Analyze complex data and translate findings into actionable insights on provider performance trends, utilization patterns, cost drivers, and outcome priorities • Liaise between data analytics teams and providers to support effective access to and use of reporting • Ensure providers obtain intended value from data • Monitor financial performance related to value-based care contracts and identify cost savings and utilization improvement opportunities • Provide leadership with recommendations based on network trends to guide decisions and advance strategic goals • Facilitate meetings with internal and external executive stakeholders to review performance, recommendations, and improvement opportunities • Identify process and efficiency improvements through AI tools and/or automation • Advance the organization’s value-based care strategy for the Illinois Medicaid market • Develop and manage provider relationships to improve health outcomes, cost efficiency, and compliance with Medicaid obligations • Develop and implement initiatives to increase provider readiness for transition from fee-for-service to value-based care models

🎯 Requirements

• 5+ years of experience in healthcare contracting, operations, data analytics, or a related role • 3 years of account management or client service experience • Excellent verbal and written communication skills • Experience developing clear, concise, and impactful materials for internal and external audiences • Experience using data management and analysis tools such as Excel, SQL, data visualization software, and/or AI solutions • Ability to identify trends, gaps, and improvement opportunities using data tools • Detail-oriented and organized • Ability to manage multiple projects simultaneously • In-depth knowledge of Medicaid reimbursement models, value-based care, and shared risk arrangements preferred • Bachelor’s degree or equivalent work experience

🏖️ 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