Lead Director, Business Performance ( Medicaid)

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.

Summary The Lead Director, Business Consulting is a strategic leadership role responsible for driving enterprise initiatives that support Medicaid business objectives, state program requirements, provider engagement strategies, and community-based partnerships. This leader will oversee a team of Senior Managers and serve as a key liaison between operational, financial, network, compliance, quality, and executive leadership teams. The Lead Director will establish and oversee reporting frameworks for strategic state-sponsored programs, financial performance monitoring, provider partnership initiatives, and community-based organization (CBO) engagement activities. The role will leverage Medicaid claims, operational, and financial data to generate actionable insights that improve member outcomes, provider performance, regulatory compliance, and organizational effectiveness. Additionally, the Lead Director will collaborate with internal subject matter experts and external partners to develop vendor cohorts, performance measurement methodologies, and outcome-based strategies that drive measurable improvements in quality, cost, access, and member experience.

Strategic Program Leadership Lead the development, implementation, and oversight of reporting solutions supporting strategic Medicaid programs and state-directed initiatives. Translate complex business objectives into actionable analytics, dashboards, and executive reporting. Identify opportunities to improve program performance through data-driven insights and operational recommendations. Serve as a strategic advisor to executive leadership on program outcomes, emerging risks, and performance trends. Reporting and Analytics Establish governance and reporting structures for: State-sponsored Medicaid initiatives Financial performance and program ROI Provider partnership performance Community-based organization engagement and outcomes Vendor performance and contractual obligations Develop executive-level scorecards, KPIs, dashboards, and performance monitoring frameworks. Utilize claims, encounter, utilization, quality, and financial data to identify trends and opportunities for improvement. Ensure reporting is accurate, timely, actionable, and aligned with organizational priorities. Provider and Community Partnership Strategy Partner with provider organizations, value-based care partners, and community-based organizations to evaluate program effectiveness and outcomes. Support the development of innovative partnerships that address health-related social needs and improve member outcomes. Monitor partnership performance and recommend corrective actions or expansion opportunities. Vendor Performance and Outcome Management Collaborate with subject matter experts across clinical, network, quality, care management, compliance, and finance functions to establish vendor cohorts and performance segmentation strategies. Develop methodologies that evaluate vendors against defined operational, financial, quality, and member outcome metrics. Drive accountability through performance reviews, improvement plans, Leadership and Stakeholder Engagement Lead, mentor, and develop a team of Senior Managers and business consultants. Foster a culture of accountability, innovation, collaboration, and continuous improvement. Build strong relationships with executives and senior leaders across matrixed organizations. Influence decisions and align stakeholders across multiple business units and competing priorities. Present program