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.

Position 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.

Key Responsibilities

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 results, insights, recommendations, and strategic analyses to senior leadership audiences.

Organizational Effectiveness

• Navigate complex organizational structures to drive cross-functional alignment and execution.
• Lead large-scale initiatives with multiple stakeholders and dependencies.
• Ensure alignment of program goals with corporate objectives, state requirements, and member needs.

Required Qualifications

• 8+ years of progressive leadership experience in healthcare, managed care, consulting, analytics, or business strategy.
• 5+ years leading high-performing teams and people leaders.
• Significant experience within Medicaid managed care organizations, state Medicaid programs, or healthcare consulting environments.
• Demonstrated experience working with healthcare claims and encounter data to drive strategic decision-making.
• Experience developing executive-level reporting and performance management frameworks.
• Proven success managing cross-functional initiatives involving multiple stakeholders and business units.

Preferred Qualifications

• Experience supporting state Medicaid contracts, quality improvement initiatives, or value-based care programs.
• Experience working with provider organizations, community-based organizations, and external vendors.
• Knowledge of social determinants of health and community partnership strategies.
• Experience with vendor oversight and outcome-based performance measurement.
• Familiarity with Medicaid quality measures, regulatory requirements, and healthcare reimbursement methodologies.
• Experience in a highly matrixed healthcare organization.

Education

• Bachelor's degree or equivalent work experience

Pay Range

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.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

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. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 09/24/2026

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