Lead Director, Business Performance – Medicaid

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Spearhead the development, execution, and management of reporting solutions that support strategic Medicaid programs and state-directed initiatives.

• Convert intricate business objectives into implementable analytics, dashboards, and executive-level reporting.

• Discover opportunities for enhancing program performance through insights derived from data and operational recommendations.

• Provide counsel to executive leadership regarding program outcomes, emerging risks, and performance trends.

• Create governance and reporting frameworks for state-sponsored Medicaid initiatives, financial performance and ROI, provider partnerships, community organization engagement, and vendor performance.

• Construct executive-level scorecards, KPIs, dashboards, and frameworks for performance monitoring.

• Examine claims, encounter, utilization, quality, and financial data.

• Collaborate with provider organizations, value-based care partners, and community organizations to assess effectiveness and outcomes.

• Facilitate innovative partnerships that tackle health-related social needs.

• Oversee partnership performance and suggest corrective actions or opportunities for expansion.

• Establish vendor cohorts and strategies for performance segmentation.

• Formulate methodologies to evaluate vendors against operational, financial, quality, and member outcome metrics.

• Foster accountability through performance reviews and improvement initiatives.

• Lead, mentor, and develop Senior Managers and business consultants.

• Cultivate relationships with executives and senior leaders across matrixed organizations.

• Deliver results, insights, recommendations, and strategic analyses to senior leadership.

• Navigate intricate organizational structures and manage large-scale cross-functional initiatives.

• Align program objectives with corporate goals, state requirements, and member needs.

⛳️ Requirements

• A minimum of 8 years of progressive leadership experience in healthcare, managed care, consulting, analytics, or business strategy.

• At least 5 years of experience leading high-performing teams and people leaders.

• Extensive experience within Medicaid managed care organizations, state Medicaid programs, or healthcare consulting environments.

• Proven track record of utilizing healthcare claims and encounter data to inform strategic decision-making.

• Experience in developing executive-level reporting and performance management frameworks.

• Demonstrated success in managing cross-functional initiatives involving multiple stakeholders and business units.

• Bachelor's degree or equivalent work experience.

• Preferred: experience in supporting state Medicaid contracts, quality improvement initiatives, or value-based care programs.

• Preferred: experience collaborating with provider organizations, community-based organizations, and external vendors.

• Preferred: understanding of social determinants of health and community partnership strategies.

• Preferred: experience in vendor oversight and outcome-based performance measurement.

• Preferred: familiarity with Medicaid quality measures, regulatory requirements, and healthcare reimbursement methodologies.

• Preferred: experience within a highly matrixed healthcare organization.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program.

• Equity award program.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being.