Note: The job is a remote job and is open to candidates in USA. CVS Health, through Aetna Better Health of Illinois, provides Medicaid services and is advancing value-based care to improve health outcomes, cost efficiency, and compliance. The Senior Manager of Medicaid Provider Performance will manage strategic provider relationships, analyze performance and utilization data, monitor value-based contract financials, and develop initiatives to transition providers toward value-based care models.
Responsibilities
- Serve as the primary point of contact for strategic provider relationships, providing day-to-day support for contract-related needs
- Perform market analyses to identify provider candidates for value-based contracts and initiate conversations with those groups
- Analyze complex data and translate findings into actionable insights, including provider performance trends, utilization patterns, cost drivers, and priorities for improved outcomes
- 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
- Monitor financial performance related to value-based care contracts and identify opportunities for cost savings and utilization improvement
- Regularly provide leadership with recommendations based on network trends to guide decision-making and advance strategic goals and objectives
- Facilitate meetings with internal and external executive stakeholders to review performance, recommendations, and opportunities for improvement
- Identify areas to improve processes and efficiency, including through the use of AI tools and/or automation
Skills
- 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, to identify trends, gaps, and improvement opportunities
- Detail-oriented, organized, and able to manage multiple projects simultaneously
- Bachelor's degree or equivalent work experience
- In-depth knowledge of Medicaid reimbursement models, value-based care, and shared risk arrangements
Benefits
- Eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
- Includes an award target in the company’s equity award program.
- Medical, dental, and vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources, based on eligibility
Company Overview