Director ,Managed Care Operations

About the Role

Oak Street Health®, a part of CVS Health, helps older adults stay healthier and live fuller lives through our 230 centers across 27 states. 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. This includes leading health plan relationships, strategy, contract negotiations and implementation, and ongoing operations and performance.

Responsibilities

• Lead strong, collaborative, and sustainable relationships with health plan partners, approaching payer relationships with a “business owner” mindset.
• Proactively identify opportunities to demonstrate Oak Street Health’s value, negotiate and manage complex value-based contracts, and resolve operational issues with urgency and accountability.
• Partner with internal stakeholders and subject matter experts to craft payer strategy, drive successful contract negotiations and implementations, monitor contract performance, and communicate strengths, risks, and opportunities to senior leadership.
• Continuously improve workflows and represent Oak Street Health with executive presence internally and externally.
• Lead and develop team members within a matrixed and rapidly evolving organization.

Requirements

• 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, 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, and performing root-cause analysis.
• 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, credentialing processes, and contract management systems and reporting tools.
• Exceptional communication, facilitation, and stakeholder management skills, with executive presence.
• Outstanding project management skills and ability to drive complex initiatives to resolution in a fast-paced environment.
• Ability to manage multiple priorities with 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.
• U.S. work authorization.
• Demonstrated alignment with Oak Street Health’s “Oaky” values: radiating positive energy, assuming good intentions, creating an unmatched patient experience, driving clinical excellence, taking ownership, being relentlessly determined.

Qualifications

Not explicitly listed as a separate section in the original text, but the requirements above cover the necessary qualifications.

Benefits

• 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.

Pay

The typical pay range for this role is $100,000.00 - $231,540.00. 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.