Medicare Performance Management Lead Director

CVS Health

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 Medicare Performance Management Lead Director will facilitate and support the business unit’s performance management. This role will assist the Arizona and Mountain Medicare Advantage market, in supporting the development and execution of performance management strategies, including: P&L financial analysis, trends, outliers, mitigation strategies, med expense and provider outlier workgroups, VBC performance, STARs, Revenue Integrity, Network Optimization, and other areas of focus as needed. Role will report to the Medicare General Manager, AZ and Mountain. The ideal candidate will not only manage business processes, but also actively influence local market performance by helping to shape the market’s bid strategy. The role will analyze Medicare business performance, expected to review both financial and medical economic information, to be a self-guiding individual that can point to issues that need to be addressed and focused on. Helps to communicate focus activities on diagnosis i.e. unit cost / utilization / value-based models / revenue management. Drives execution of pricing commitments and corrective action plans. Creates a metrics driven management process that allows the segment to understand measured performance, to deliver on the strategic objectives, cost containment activity, and new initiatives to identify and pursue opportunities for further alignment across the Medicare Advantage market and segment leadership teams. The Lead Director role will be a liaison between senior management and local market leaders. This role will identify and lead: Performance Improvement opportunities relating to Medicare Advantage

Requirements

10+ years’ experience with several of the following: performance management, revenue integrity, VBC, STARs, management consulting, project consulting, business process consulting, financial strategic analysis, mergers and acquisitions, strategic business planning, and/or risk management consulting.
Experience with enterprise-wide and/or cross-functional large-scale initiatives with a high degree of complexity.
Demonstrated experience successfully implementing change in complex organizations.
Demonstrated superior business process, project management and organizational redesign experience.
Demonstrated leadership with relevant initiatives: Business process, enterprise business project management/consulting, financial strategic planning and analysis, mergers and acquisitions, strategic planning, risk management.
Demonstrated relationship management skills at the senior level; capacity to quickly build and maintain credible relationships at varying levels of the organization simultaneously.

Nice To Haves

Creating Profitable Partnerships
Collaborating for Results
Developing and Executing Strategy
Communicating for Impact
Engaging and Developing People
Desktop Tools - Microsoft PowerPoint/1-3 Years/End User
Database - Hyperion Essbase/1-3 Years/End User
Database - Microsoft Access/1-3 Years/End User
Management - Management - Medicare/7-10 Years
Finance - Financial analysis - P&L support/7-10 Years
Project Management - Plan management/7-10 Years
Management - Management - Process and quality improvement/7-10 Years

Responsibilities

Manage process for identification of areas to prioritize performance improvement
Review Key Performance Metrics
Help establish targets
Supports Local Market General Manager
Develop a project management framework for driving accountability
Developing monthly Performance Excellence agenda and facilitating meetings and follow-ups
Management process such as Pricing Commitments, deep dives, performance/ scorecard and takeaways that align to execution of Strategy
Identifying, prioritizing and driving alignment opportunities for partnership with local General Managers, Director of Operations, CFOs, Medical Directors, Network Managers, Medical Economics, and Pricing Actuaries.
Med Expense Workgroup
Financial outliers workgroup
Provider outlier workgroup
Network Optimization
STARs
VBC performance