Senior Manager, Medicaid Provider Performance

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. Aetna Better Health of Illinois is part of Aetna® and the CVS Health® family, one of our country’s leading health care organizations. We’ve been serving people who use Medicaid services for over 30 years; from kids, adults and seniors to people with disabilities or other serious health issues. The Senior Manager of Medicaid Provider Performance is a vital role in advancing the organization’s value-based care (VBC) strategy for the Illinois Medicaid Market. This position is essential to developing and managing provider relationships that drive improved health outcomes, cost efficiency, and compliance with state and federal Medicaid obligations. Critical will be developing and implementing strategic initiatives to increase provider readiness from traditional fee-for-service models to value-based care models.

Serve as the primary point of contact for strategic provider relationships, providing day-to-day support for contract-related needs. Perform market analyses to identify provider candidates for value-based contracts and initiate conversations with those groups. Analyze complex data and translate findings into actionable insights, including provider performance trends, utilization patterns, cost drivers, and priorities for improved outcomes. Act as a liaison between data analytics teams and providers to support effective use of and access to reporting and ensure providers obtain the intended value from data. Monitor financial performance related to value-based care contracts and identify opportunities for cost savings and utilization improvement. Regularly provide leadership with recommendations based on network trends to guide decision-making and advance strategic goals and objectives. Facilitate meetings with internal and external executive stakeholders to review performance, recommendations, and opportunities for improvement. Identify areas to improve processes and efficiency, including through the use of AI tools and/or automation.

5+ years of experience in healthcare contracting, operations, data analytics, or a related role. 3 years of account management or client service experience Excellent verbal and written communication skills Experience developing clear, concise, and impactful materials for internal and external audiences. Experience using data management and analysis tools, such as Excel, SQL, data visualization software, and/or AI solutions, to identify trends, gaps, and improvement opportunities. Detail-oriented, organized, and able to manage multiple projects simultaneously.

In-depth knowledge of Medicaid reimbursement models, value-based care, and shared risk arrangements.

Bachelor’s degree or equivalent work experience Pay Range The typical pay range for this role is: $82,940.00 - $182,549.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.  This position also includes an award target in the company’s equity award program.    Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague