Manager, Medicaid Provider Performance

CVS Health•Work At Home-Illinois, IL

1d•$66,330 - $145,860

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. Aetna Better Health of Illinois is part of Aetna® and the CVS Health® family, one of our country’s leading health care organizations. We’ve been serving people who use Medicaid services for over 30 years; from kids, adults and seniors to people with disabilities or other serious health issues. Our Manager of Medicaid Provider Performance is a vital role in advancing the organization’s value-based care (VBC) strategy for the Illinois Medicaid Market. This position is essential to developing and managing provider relationships that drive improved health outcomes, cost efficiency, and compliance with state and federal Medicaid obligations. Critical will be developing and implementing strategic initiatives to increase provider readiness from traditional fee-for-service models to value-based care models.

Requirements

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.

Nice To Haves

Familiarity with Medicaid reimbursement models, value-based care, and shared risk arrangements.

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.