Senior Manager, Medicaid Provider Performance

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

📋 Description

• Act as the main contact for strategic provider partnerships and deliver daily support for contract-related requirements.

• Conduct market analyses to pinpoint potential provider candidates for value-based contracts and initiate discussions with provider groups.

• Examine intricate data and convert insights into actionable recommendations regarding provider performance trends, utilization patterns, cost drivers, and outcome priorities.

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

• Ensure that providers derive intended value from data.

• Oversee financial performance related to value-based care contracts while identifying opportunities for cost savings and utilization improvements.

• Provide leadership with strategic recommendations based on network trends to support decision-making and advance organizational goals.

• Organize meetings with internal and external executive stakeholders to discuss performance, recommendations, and opportunities for improvement.

• Identify process and efficiency enhancements through AI tools and/or automation.

• Promote the organization’s value-based care strategy within the Illinois Medicaid market.

• Cultivate and manage provider relationships to enhance health outcomes, cost efficiency, and compliance with Medicaid obligations.

• Create and execute initiatives to bolster provider readiness for transitioning from fee-for-service to value-based care models.

⛳️ Requirements

• Over 5 years of experience in healthcare contracting, operations, data analytics, or a related field.

• A minimum of 3 years of experience in account management or client services.

• Exceptional verbal and written communication abilities.

• Proficient in developing clear, concise, and impactful materials for both internal and external audiences.

• Familiarity with data management and analysis tools such as Excel, SQL, data visualization software, and/or AI solutions.

• Capability to identify trends, gaps, and opportunities for improvement utilizing data tools.

• Highly detail-oriented and organized.

• Ability to handle multiple projects at once.

• In-depth understanding of Medicaid reimbursement models, value-based care, and shared risk arrangements is preferred.

• Bachelor’s degree or equivalent professional 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.

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