Lead Director, VBP Transformation - reside in Louisiana

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.

Candidates for this role must reside in Louisiana. The Sr. Director of Value Based Payment Transformation (Sr. Director) is a key part of the Aetna Better Health of Louisiana leadership team, reporting to the CEO. This role is responsible for the performance oversight, regulatory reporting, internal/external communications, and ongoing management and oversight of VBP contractual responsibilities with the Louisiana Department of Health (LDH).

The Sr. Director will work in close partnership with the CEO, COO, CFO, and all internal matrixed growth partners to implement, manage, and drive the overall success of advanced Alternative Payment Models (APMs). The Sr. Director will be the primary senior leader responsible for ongoing VBP related communications and coordination with DMAS. Candidates must live in Louisiana or be willing to relocate.

• Development of strong relationships and provider engagement on VBP models through recurring in-person and virtual meetings with management to executive leadership of small to large provider groups and systems.
• Support providers VBP readiness and success through ongoing education, surveys, VBP model overviews and performance updates.
• Identify and execute performance improvement initiatives in partnership with providers and multiple internal matrixed growth partners.
• Implement processes to share data and performance reports monthly with participating VBP providers.

• Partner with multiple informatics teams to design and develop advanced self-service VBP reporting and dashboards to understand actionable insights that drive multi-year strategies.
• Regularly assess and communicate to internal and external stakeholders the financial performance of all implemented APMs.
• Achieve annual financial performance targets tied to VBP.
• Leverage advanced Excel, SQL, and other analytics skills to conduct ad-hoc analysis of large data sets.

• Implement and execute VBP contractual requirements and initiatives, including the annual updated VBP Strategic Plan to drive ongoing model improvement.
• Fielding and coordinating responses to VBP related State inquiries.
• Conducting quality reviews of all regulatory VBP reports prior to submission.
• Participating in all regulatory and internal VBP work groups/meetings and owning key action items.

• 3+ years of Value-Based / Alternative Payment Model experience.
• 3+ years of Medicaid payer experience.
• 1+ years of experience interpreting and executing contractual and/or regulatory language and managing oversight of regulatory requirements.
• Deep understanding of health plan operations and data, including Quality and NCQA HEDIS, provider contracting & credentialing, claims/encounters processing, utilization management, case management, network access requirements, and Medicaid eligibility and capitation.
• Advanced data analytics skills, including advanced Excel, intermediate+ SQL (Power BI experience preferred).
• Strong presentation skills and communication skills to executive level audiences, both written and verbal.
• Successfully able to navigate and influence associates across all levels in a large matrixed organization.

Excellent organization and time management skills.

5+ years of developing and executing project plans and engineering or re-engineering business workflows and technical processes.

Bachelor's Degree or equivalent experience.

Typical Pay Range: $ - $.

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…