Operations Lead, DUAL Program Management

CVS Health•Hartford, CT

4d•$75,400 - $199,144

About The Position

Under the direction of the Lead Director, Health Plan Market Operations, the Operations Lead oversees day-to-day health plan operations across Integrated Plans. The role ensures operational readiness, regulatory compliance, and effective execution of strategic initiatives, serving as a primary liaison among market leadership, enterprise partners, shared services teams, and regulatory stakeholders. The Operations Lead oversees critical operational functions, monitors performance and compliance, identifies and mitigates risks, drives issue resolution, and aligns strategic priorities with daily execution. The position also supports member outcomes through cross-functional coordination, readiness and implementation work, audit support, executive reporting, financial remediation, and operational leadership during critical incidents and regulatory escalations.

Requirements

At least 7 years of healthcare operations, managed care, health plan administration, regulatory compliance, or related experience.
At least 5 years of experience leading cross-functional operational initiatives and driving organizational outcomes.
Experience supporting Dual Eligible Special Needs Plans (D-SNP), FIDE, HIDE, or MLTSS.
Strong knowledge of CMS and 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 a related field, or an 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; escalate risks and develop remediation strategies as needed.
Develop and maintain operational workplans, readiness trackers, risk logs, and reporting tools for leadership visibility and accountability.
Drive issue management, facilitate cross-functional discussions, 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 by coordinating 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 reports and presentations communicating operational performance, readiness status, risks, issues, and mitigation plans.
Act as an operational subject matter expert and primary point of contact for internal stakeholders regarding Integrated Plan operations.
Support financial remediation by identifying operational drivers of financial performance and partnering with business owners on corrective actions.
Maintain 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; coordinate action plans and ensure timely resolution.
Support additional Health Plan Market Operations activities and provide cross-functional support as business needs require.