Director ,Managed Care Operations

CVS Health · United States

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. Job Overview: Oak Street Health®, a part of CVS Health, helps older adults stay healthier and live fuller lives through our 230 centers across 27 states. Our value-based care model helps us consistently deliver better patient experiences and outcomes. As a Director, Managed Care Operations, you will play a critical role in supporting our Oak Street Health patients, providers and business by leading Oak Street Health’s partnerships with national and regional Medicare Advantage health plans, including leading health plan relationships, strategy, contract negotiations and implementation, and ongoing operations and performance. This position plays a critical role in OSH’s mission and growth by advancing our value‑based care model by leading strong, collaborative, and sustainable relationships with our health plan partners. This leader approaches payer relationships with a “business owner” mindset, proactively identifying opportunities to demonstrate Oak Street Health’s value, negotiating and managing complex value‑based contracts, and resolving operational issues with urgency and accountability. The role partners closely with key internal stakeholders and subject matter experts, including company executives, clinical, finance, data, population health, membership, engagement, legal, and field leaders, to craft payer strategy, drive successful contract negotiations and implementations, monitor contract performance, communicate strengths, risks and opportunities to senior leadership, and continuously improve workflows. The position also includes responsibility for leading and developing team members and representing Oak Street Health with executive presence internally and externally. Required Qualifications

• 5-6+ years of experience managing Medicare Advantage payer relationships and leading full-risk contracting and operations at a value‑based primary care organization
• Proven success leading contract strategy and negotiating and managing value‑based contracts, with a mastery of key financial and operational terms and provider incentive design
• Exceptional financial and analytical acumen, including experience evaluating contract economics, monitoring performance, performing root‑cause analysis, and communicating accordingly to senior leadership
• Complete understanding of value-based primary care and Medicare Advantage operations, including Stars performance optimization and membership attribution
• Existing relationships with network contracting leaders at both national and regional Medicare Advantage health plans
• Deep experience with payer‑provider data‑sharing frameworks, provider roster management and credentialing processes, and contract management systems and reporting tools
• Exceptional communication, facilitation, and stakeholder management skills, with executive presence and the ability to be personable yet persistent
• Outstanding project management skills; ability to independently drive complex initiatives to resolution in a fast‑paced environment
• Ability to manage multiple priorities while maintaining strong attention to detail and sound business judgment
• Mastery of Microsoft Excel, Word, PowerPoint, and similar tools
• Ability to travel for occasional in‑person payer and team meetings
• Proven people leadership experience, including managing, developing, and mentoring associates within matrixed and rapidly evolving organizations
• U.S. work authorization

• Radiating positive energy
• Assuming good intentions
• Creating an unmatched patient experience
• Driving clinical excellence
• Taking ownership and delivering results
• Being relentlessly determined

• Mission-focused career impacting change and measurably improving health outcomes for medicare patients
• Paid vacation, sick time, and investment/retirement 401K match options
• Health insurance, vision, and dental benefits
• Opportunities for leadership development and continuing education stipends
• New centers and flexible work environments
• Opportunities for high levels of responsibility and rapid advancement