Operations Lead, DUAL Program Management

CVS Health•Hartford, CT

2d•$75,400 - $199,144

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. Under the direction of the Lead Director, Health Plan Market Operations, the Operations Lead is responsible for overseeing day-to-day health plan operations, ensuring operational readiness, regulatory compliance, and effective execution of strategic initiatives across Integrated Plans. This role serves as the primary liaison between market leadership, enterprise partners, shared services teams, and regulatory stakeholders to ensure operational excellence and successful member outcomes. The Operations Lead provides oversight of critical operational functions, monitors performance and compliance, identifies and mitigates operational risks, drives issue resolution, and ensures alignment between strategic priorities and daily execution. This role requires strong leadership, cross-functional collaboration, and the ability to influence outcomes across multiple organizational areas.

Requirements

7+ years of healthcare operations, managed care, health plan administration, regulatory compliance, or related experience.
5+ years of experience leading cross-functional operational initiatives and driving organizational outcomes.
Experience supporting Dual Eligible Special Needs Plans (D-SNP), FIDE, HIDE, MLTSS
Strong knowledge of CMS, state regulatory requirements, health plan operations, and audit readiness processes.
Experience developing executive-level reports, presentations, and operational performance dashboards.
Demonstrated ability to influence stakeholders and drive issue resolution without direct authority.
Experience leading operational readiness, implementation, or transformation initiatives.
Strong analytical, problem-solving, and decision-making skills.
Excellent verbal, written, and presentation communication skills.
Advanced proficiency in Microsoft Excel, PowerPoint, and data analysis tools
Bachelor's degree in Business Administration, Healthcare Administration, Public Health, Operations Management, or related field, or equivalent combination of education and experience.

Responsibilities

Provide operational oversight and coordination across health plan functional areas to support efficient and compliant service delivery.
Lead cross-functional efforts to identify, prioritize, and resolve operational issues affecting members, providers, regulators, and business partners.
Establish and maintain operational readiness processes for annual implementation activities, including product launches, benefit changes, regulatory requirements, and market expansions.
Monitor operational performance, service levels, regulatory requirements, and business outcomes, escalating risks and developing remediation strategies as needed.
Develop and maintain operational workplans, readiness trackers, risk logs, and reporting tools to support leadership visibility and accountability.
Drive issue management processes, facilitating cross-functional discussions to identify root causes, implement corrective actions, and prevent future operational impacts.
Partner with enterprise shared services teams, including claims, enrollment, member services, care management, provider services, and compliance, to ensure seamless operational execution.
Support state, CMS, NCQA, and internal audit activities through coordination of documentation, evidence collection, remediation planning, and progress reporting.
Monitor regulatory changes and contract requirements to ensure timely operational implementation and ongoing compliance.
Develop executive-level reporting and presentations that communicate operational performance, readiness status, risks, issues, and mitigation plans. Act as a trusted operational subject matter expert and primary point of contact for internal and stakeholders regarding Integrated Plan operations.
Support financial remediation efforts by identifying operational drivers of financial performance and partnering with business owners to implement corrective actions.
Maintain strong relationships with market leaders, executive leadership, enterprise partners, regulators, and community stakeholders to support business objectives and member outcomes.
Provide operational leadership during critical incidents, readiness events, and regulatory escalations, coordinating action plans and ensuring timely resolution.
Support additional Health Plan Market Operations activities and provide cross-functional support as business needs require.