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VP, Operations - Accountable Care

In 2021, CVS Health launched a risk bearing entity called the CVS Accountable Care organization. We contract directly with CMS on full risk model for the Medicare Fee For Service Population. CVS Accountable Care contract and partner with various provider types to enable them to be successful in this value-based program by providing various products and services that includes but not limited to analytics, population health services, care management, clinical programs, accurate clinical documentation training and education and practice transformation. This unique program allows providers to be more effective in Value Based Care model and drive to better clinical outcome for the Medicare population as well as more satisfaction for their doctors. As of Fall 2024, our provider network includes 70K providers in 41 states. We currently service commercial and various Medicare programs.

The VP of Accountable Care Operations will be responsible for operationalizing AC strategies to meet internal and external objectives. This includes oversight of the Informatics, Analytics & Governance Digital & Technological Innovation, Analytics, and Accurate Clinical documentation teams. This role will drive innovation, facilitate cross functional collaboration and contribute to the overall improvement of healthcare outcomes for traditional Medicare and Medicare Advantage beneficiaries through the effective use of data.    Our strategy is focused on operational execution to deliver results across key business and clinical metrics by making relevant data available at the time of interaction with the goal of enhancing the overall experience of our provider partners and beneficiaries in value-based care arrangements. While also making sure we are setting up our organization for future scalability. Scope of work includes developing and executing strategy, leadership direction, talent development, cultivating and managing external vendor relationships, assessing vendor offerings and services, identifying strategic, innovative solutions to support the organization’s informatics and interoperability goals, and leading matrixed teams to ensure successful delivery of business strategy.

Key Responsibilities

• Responsible for all operational matters for the AC business which includes client implementations, vendor management, risk adjustment, the informatics and interoperability strategy

• Oversees the implementation, and maintenance of information systems, such as data analytics platforms, electronic health records, and other informatic tools.

• Establishes and enforces data governance policies and procedures to ensure data quality, privacy, and compliance with relevant regulations.

• Defines data standards, establishes data management protocols, and promotes and supports data-driven decision-making throughout the organization.

• Explores opportunities for innovation, scale and research collaborations to drive continuous improvement in informatics and interoperability capabilities and outcomes.

• Leads of team of informatics and interoperability professionals by providing guidance, mentorship, and support to ensure the team has the necessary resources and skills to achieve organizational goals.

• Ensuring CVS AC has necessary technology infrastructure to support business needs and scale for growth.

• Responsible for identifying and deploying strategies around interoperability and making patient opportunities available at point of care.

• Enhance automated accurate documentation prompts in native systems in collaboration with provider partners.

• Serve as industry SME with Epic vendor, and within CVS Health, on capability roadmap to enhance value-based care.

• Build process to ingest and curate CMS, Provider, Health Plan, and SDOH data into personalized tailored dashboards for key stakeholder community to monitor beneficiary stratification, management, and program/ intervention outcomes.

• Foster provider engagement and create accountability for internal chart review access and participation in online education sessions.

Qualifications

• Approximately 15 years’ experience in health insurance industry

• Strong knowledge of Value Based Contracting

• Strong knowledge of ACOs

• Deep experience with Medicare Advantage VBC models

• Risk Adjustment experience will be valued

• Deep knowledge of population health management programs

• Comfortable meeting with clients

• Strong operational mind-set

• Growth mind-set

• Data-Driven: leverages data and insights to make informed business decisions; incorporates appropriate insights into business deliverables

• Remote - working East Coast hours

Education

Bachelor's degree, or an equivalent combination of formal education and experience.

We anticipate the application window for this opening will close on: 11/26/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. 

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through [email protected] If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.