Manager, Managed Care Directed Payments

CVS Health•Work At Home-Oklahoma, OK

6d•$54,300 - $119,340•Onsite

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 The Manager, Managed Care Directed Payments is a strategic leadership role responsible for the design, implementation, and ongoing management of Directed Payment Programs (DPPs) in alignment with SoonerSelect requirements and Oklahoma Health Care Authority (OHCA) guidelines. This role serves as a critical liaison between OHCA, internal teams (including Claims, Finance, and Compliance), and external provider partners. The Manager ensures accurate and timely payment execution, fosters strong provider relationships, and maintains full compliance with evolving regulatory requirements. As a designated key staff position, this role plays a vital part in supporting organizational success within Oklahoma’s Medicaid managed care environment and must be based in Oklahoma.

Requirements

5+ years of healthcare experience, with a strong background in claims operations
Demonstrated experience partnering directly with healthcare providers to resolve complex issues
Solid understanding of Medicaid managed care, payment methodologies, and regulatory frameworks
Proven leadership skills with the ability to manage cross-functional initiatives and stakeholders

Nice To Haves

Direct experience with SoonerSelect Medicaid managed care programs
Advanced knowledge of Medicaid payment methodologies and state/federal regulatory requirements
Ideal will reside in Oklahoma

Responsibilities

Lead the development, execution, and optimization of Directed Payment Programs (DPPs)
Ensure compliance with SoonerSelect and OHCA regulatory and reporting requirements
Partner cross-functionally with Claims, Finance, Compliance, and other internal teams to ensure accurate payment processing
Act as the primary point of contact for providers, addressing complex payment issues and strengthening engagement
Monitor program performance, identify risks, and implement process improvements
Interpret regulatory guidance and translate requirements into actionable operational processes
Support audits, reporting, and documentation related to directed payment programs
Provide leadership across cross-functional initiatives, driving alignment and outcomes