Medicare Performance Management Lead Director at CVS Health

Cary, North Carolina, United States

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Not SpecifiedCompensation

Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

10+ years’ experience with several of the following methodologies: 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

Responsibilities

Facilitate and support implementation of the business unit’s management process and operating model
Assist the Carolinas and Tennessee Medicare Advantage market in supporting the development and execution of market strategies, including development of market level Medicare Advantage product and network strategies, execution of pricing commitments, and management process to ensure development and execution of the plan
Continuously improve management practices to enable collaboration and shared accountability for success
Manage business processes and actively influence local market performance by helping to shape and drive the market’s bid strategy
Analyze Medicare business performance, reviewing both financial and medical economic information, to identify issues that need to be addressed
Communicate focus activities on diagnosis (e.g., unit cost/utilization/value-based models/revenue management)
Drive execution of pricing commitments and corrective action plans
Create a metrics-driven management process to understand measured performance and deliver on strategic objectives, cost containment activity, growth objectives, and new initiatives
Identify and pursue opportunities for further alignment across the Medicare Advantage market and segment leadership teams
Act as a liaison between senior management and local market leaders
Identify and lead process improvement opportunities relating to Medicare Advantage
Manage process for identification of areas to prioritize performance improvement
Review key performance metrics and help establish targets
Bring segment/product priorities to the market for local execution
Support local market general manager
Develop a project management framework for driving accountability
Develop monthly Performance Excellence agenda and facilitate meetings and follow-ups
Manage processes such as pricing commitments, market visits, deep dives, performance/scorecard, and takeaways that align to execution of strategy
Identify, prioritize, and drive alignment opportunities across markets
Enable operating model for partnership with local general managers, director of operations, CFOs, medical directors, network managers, medical economics, and pricing actuaries

Skills

Medicare Advantage

Performance Management

Market Strategy

Product Strategy

Network Strategy

Pricing Strategy

Financial Analysis

Medical Economics

Unit Cost Analysis

Utilization Management

Value-Based Models

Revenue Management

Metrics-Driven Management

Cost Containment

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters

1963Year Founded

DEBTCompany Stage

Healthcare, Consumer GoodsIndustries

10,001+Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.

The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.

The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.

The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.

CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.

Increased consumer interest in wellness boosts demand for CVS's health-related products.

The trend towards value-based care aligns with CVS's integrated healthcare approach.

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