Senior Manager, Medicaid Provider Performance

Aetna Better Health of Illinois, part of Aetna® and the CVS Health® family, is a leading health care organization serving people who use Medicaid services. We’ve been serving Illinois Medicaid members—including kids, adults, seniors, and people with disabilities or serious health issues—for over 30 years.

About the role

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. You will develop and implement strategic initiatives to increase provider readiness from traditional fee-for-service models to value-based care models.

Responsibilities

• 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.

Requirements

• 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.

Qualifications

• Bachelor’s degree or equivalent work experience.

Preferred Qualifications

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

Pay

The typical pay range for this role is $82,940.00 - $182,549.00 annually. This range represents the base salary and may vary based on experience, education, geography, and other relevant factors. This position is also eligible for a CVS Health bonus, commission, or short-term incentive program, as well as an award target in the company’s equity award program.

Benefits

This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families, including:

• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources.