Lead Director, VBP Transformation - Must reside in Louisiana

CVS Health • Kenner, LA

2d • $100,000 - $231,540

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Candidates for this role must reside in Louisiana. The Sr. Director of Value Based Payment Transformation (Sr. Director) is a key part of the Aetna Better Health of Louisiana leadership team, reporting to the CEO. This role is responsible for the performance oversight, regulatory reporting, internal/external communications, and ongoing management and oversight of VBP contractual responsibilities with the Louisiana Department of Health (LDH). The Sr. Director will work in close partnership with the CEO, COO, CFO, and all internal matrixed growth partners to implement, manage, and drive the overall success of advanced Alternative Payment Models (APMs). The Sr. Director will be the primary senior leader responsible for ongoing VBP related communications and coordination with DMAS. Candidates must live in Louisiana or be willing to relocate.

Requirements

• 3+ years of Value-Based / Alternative Payment Model experience
• 3+ years of Medicaid payor experience
• 1+ years of experience interpreting and executing contractual and/or regulatory language and managing oversight of regulatory requirements.
• Deep understanding of health plan operations and data, including Quality and NCQA HEDIS, provider contracting & credentialing, claims/encounters processing, utilization management, case management, network access requirements, and Medicaid eligibility and capitation.
• Advanced data analytics skills, including advanced Excel, intermediate+ SQL (Power BI experience preferred)
• Strong presentation skills and communication skills to executive level audiences, both written and verbal
• Successfully able to navigate and influence associates across all levels in a large matrixed organization.
• Excellent organization and time management skills

Nice To Haves

• 5+ years of developing and executing project plans and engineering or re-engineering business workflows and technical processes.

Responsibilities

• Provider Engagement
• Development of strong relationships and provider engagement on VBP models through recurring in-person and virtual meetings with management to executive leadership of small to large provider groups and systems.
• Support providers VBP readiness and success through ongoing education, surveys, VBP model overviews and performance updates.
• Identify and execute performance improvement initiatives in partnership with providers and multiple internal matrixed growth partners.
• Implement processes to share data and performance reports monthly with participating VBP providers.
• Performance and Reporting
• Partner with multiple informatics teams to design and develop advanced self-service VBP reporting and dashboards to understand actionable insights that drive multi-year strategies.
• Regularly assess and communicate to internal and external stakeholders the financial performance of all implemented APMs.
• Achieve annual financial performance targets tied to VBP
• Leverage advanced Excel, SQL, and other analytics skills to conduct ad-hoc analysis of large data sets
• Regulatory VBP implementation, management, and oversight
• Implement and execute VBP contractual requirements and initiatives, including the annual updated VBP Strategic Plan to drive ongoing model improvement.
• Fielding and coordinating responses to VBP related State inquiries
• Conducting quality reviews of all regulatory VBP reports prior to submission
• Participating in all regulatory and internal VBP workgroups/meetings and owning key action items

Benefits

• This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families.
• The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
• Additional details about available benefits are provided during the application process and on Benefits Moments.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Number of Employees: 5,001-10,000 employees