Manager, Medicaid Provider Performance

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

📋 Description

• Act as a reliable partner to strategic providers, addressing contract-related challenges and providing effective solutions.

• Oversee operational processes that align with value-based care goals.

• Evaluate provider performance trends, utilization patterns, cost determinants, and areas for enhancement.

• Track financial and clinical outcomes for value-based care agreements.

• Discover opportunities for cost reduction and utilization enhancements.

• Develop data-driven materials for both internal and external stakeholders.

• Organize meetings with provider leadership teams to discuss performance and present recommendations.

• Serve as an intermediary between data analytics teams and providers to facilitate reporting access and effective utilization of data.

• Identify improvements in processes and efficiency through the use of AI tools and automation.

⛳️ Requirements

• 2–4 years of experience in healthcare operations, data analytics, administration, or a related field.

• Proficient in data management and analysis tools including Excel, SQL, data visualization software, and/or AI solutions.

• Capable of identifying trends, gaps, and opportunities for improvement.

• Skilled in converting complex performance data into clear, executive-ready documents.

• Excellent communication and interpersonal skills.

• Ability to work collaboratively with internal and external stakeholders at all levels.

• Detail-oriented and highly organized.

• Competent in managing multiple projects simultaneously.

• Knowledge of Medicaid reimbursement models, value-based care, and shared risk agreements.

• Bachelor’s degree or equivalent professional experience.

🏝️ Benefits

• CVS Health bonus, commission or short-term incentive program in addition to base pay.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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