Operations Lead, DUAL Program Management

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Position Summary
Under the direction of the Lead Director Health Plan Market Operations the Operations Lead is responsible for overseeing day-to-day health plan operations ensuring operational readiness regulatory compliance and effective execution of strategic initiatives across Integrated Plans. This role serves as the primary liaison between market leadership enterprise partners shared services teams and regulatory stakeholders to ensure operational excellence and successful member outcomes.

The Operations Lead provides oversight of critical operational functions monitors performance and compliance identifies and mitigates operational risks drives issue resolution and ensures alignment between strategic priorities and daily execution. This role requires strong leadership cross-functional collaboration and the ability to influence outcomes across multiple organizational areas.

Provide operational oversight and coordination across health plan functional areas to support efficient and compliant service delivery.

Lead cross-functional efforts to identify prioritize and resolve operational issues affecting members providers regulators and business partners.

Establish and maintain operational readiness processes for annual implementation activities including product launches benefit changes regulatory requirements and market expansions.

Monitor operational performance service levels regulatory requirements and business outcomes escalating risks and developing remediation strategies as needed.

Develop and maintain operational workplans readiness trackers risk logs and reporting tools to support leadership visibility and accountability.

Drive issue management processes facilitating cross-functional discussions to identify root causes implement corrective actions and prevent future operational impacts.

Partner with enterprise shared services teams including claims enrollment member services care management provider services and compliance to ensure seamless operational execution.

Support state CMS NCQA and internal audit activities through coordination of documentation evidence collection remediation planning and progress reporting.

Monitor regulatory changes and contract requirements to ensure timely operational implementation and ongoing compliance.

Develop executive-level reporting and presentations that communicate operational performance readiness status risks issues and mitigation plans. Act as a trusted operational subject matter expert and primary point of contact for internal and stakeholders regarding Integrated Plan operations.

Support financial remediation efforts by identifying operational drivers of financial performance and partnering with business owners to implement corrective actions. Maintain strong relationships with market leaders executive leadership enterprise partners regulators and community stakeholders to support business objectives and member outcomes. Provide operational leadership during critical incidents readiness events and regulatory escalations coordinating action plans and ensuring timely resolution.

Support additional Health Plan Market Operations activities and provide cross-functional support as business needs require.

Required Qualifications

• 7 years of healthcare operations managed care health plan administration regulatory compliance or related experience.
• 5 years of experience leading cross-functional operational initiatives and driving organizational outcomes.
• Experience supporting Dual Eligible Special Needs Plans (D-SNP) FIDE HIDE MLTSS
• Strong knowledge of CMS state regulatory requirements health plan operations and audit readiness processes.
• Experience developing executive-level reports presentations and operational performance dashboards.
• Demonstrated ability to influence stakeholders and drive issue resolution without direct authority.
• Experience leading operational readiness implementation or transformation initiatives.
• Strong analytical problem-solving and decision-making skills.
• Excellent verbal written and presentation communication skills.
• Advanced proficiency in Microsoft Excel PowerPoint and data analysis tools
• Bachelors degree in Business Administration Healthcare Administration Public Health Operations Management or related field or equivalent combination of education and experience.

Pay Range

The typical pay range for this role is:

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 companys 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.

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

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