VP, Managed Care Contracting & Operations - Oak Street Health at CVS Health

Chicago, Illinois, United States

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Not SpecifiedCompensation

Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

15+ years of healthcare experience, including contracting, medical economics, and provider partnerships
Deep expertise in value-based contracting models with proven success in full-risk arrangements
Existing relationships with network contracting leaders at major payors (highly valued)
Strong understanding of financial levers in risk-based arrangements and provider incentive design
Experience with delegated risk models and governance
Knowledge of Medicare Advantage, CMS/CMMI programs, and Stars performance optimization
Proven success in matrixed organizations undergoing rapid growth and transformation
Executive presence with excellent communication and stakeholder management skills
Strong analytics and financial acumen; ability to perform root cause analysis
Experience with interoperability strategies and provider data-sharing frameworks
Familiarity with credentialing processes and compliance requirements
Advanced proficiency in contract management systems and reporting tools
Ability to travel for in-person provider and payor meetings

Responsibilities

Develop and execute a national value-based care contracting strategy aligned with enterprise growth objectives
Lead the design and implementation of next-generation payment models, including full-risk and capitation arrangements
Oversee governance for value-based care, including contract templates, policies, and procedures for regional teams
Direct all payor contracting activities across national and regional payors
Design low-cost network structures and financial arrangements that optimize quality and efficiency
Collaborate across the OSH operational teams including but not limited to Stars, delegated functions like CM and UM, Medical Economics, and growth
Ensure seamless integration of contract requirements other data systems into VBC reporting and reconciliation workflows
Implement provider tiering frameworks and targeted interventions to improve outcomes and reduce cost
Partner with interoperability teams to develop a comprehensive provider data-sharing strategy
Monitor contract performance, analyze financial implications, and communicate risk insights to senior leadership
Develop dashboards and reporting tools for contract performance and compliance
Drive continuous improvement initiatives and workflow optimization
Partner with finance, clinical operations, and legal teams to operationalize agreements
Serve as primary liaison with health plans, fostering collaborative relationships and advancing innovative care models
Represent Oak Street Health in high-level discussions with payors and industry stakeholders
Manage and mentor a high-performing team responsible for contracting and credentialing
Build organizational capability to support rapid growth and transformation

Skills

Value-Based Care

Payer Contracting

Capitation Arrangements

Credentialing

Performance Management

Contract Negotiation

Provider Tiering

Medical Economics

Utilization Management

Case Management

Network Design

Interoperability

Data Integration

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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