Note: The job is a remote job and is open to candidates in USA. CVS Health is a healthcare organization whose Aetna Better Health of Illinois business provides Medicaid services and advances value-based care. The Manager, Medicaid Provider Performance develops provider relationships, leads value-based care operations, analyzes performance data, monitors contract outcomes, and delivers actionable insights to stakeholders in support of improved health outcomes, cost efficiency, and Medicaid compliance.
Responsibilities
- Serve as trusted partner to strategic providers, resolving contract-related issues, conducting targeted research, and delivering practical solutions for ad hoc and ongoing needs
- Lead execution of operational processes that support value-based care objectives
- Analyze complex data and translate findings into actionable insights, including provider performance trends, utilization patterns, cost drivers, and priorities for improved outcomes
- Monitor financial and clinical performance related to value-based care contracts, identifying opportunities for cost savings and utilization improvement
- Create data-driven materials to present to internal and external stakeholders, translating performance trends into clear insights and opportunities for action
- Coordinate meetings with provider leadership teams to review performance, recommendations, and opportunities for improvement
- Act as a liaison between data analytics teams and providers to support effective use of and access to reporting and ensure providers obtain the intended value from data
- Identify areas to improve processes and efficiency, including through the use of AI tools and/or automation
Skills
- * 2-4 years of experience in healthcare operations, data analytics, administration, or a related role
- * Skilled in using data management and analysis tools, such as Excel, SQL, data visualization software, and/or AI solutions, to identify trends, gaps, and improvement opportunities
- * Proficient in translating complex performance information into clear, executive-ready materials
- * Strong communication and interpersonal skills, with the ability to collaborate effectively with internal and external stakeholders at all levels
- * Detail-oriented, organized, and able to manage multiple projects simultaneously
- * Bachelor's degree or equivalent work experience
- * Familiarity with Medicaid reimbursement models, value-based care, and shared risk arrangements
Benefits
- This position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families.
- Medical, dental, and vision coverage, based on eligibility
- Paid time off, based on eligibility
- Retirement savings options, based on eligibility
- Wellness programs, based on eligibility
- Other resources, based on eligibility
- This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
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