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Specialty Program Evaluation and Outcomes Director

at CVS Health

Posted: 3/18/2020
Job Reference #: 1240119BR

Job Description

Job Description
The Specialty Program Evaluation and Outcomes Director will provide the leadership and oversight for client-focused reporting and analysis, as well as the client guarantees, risk contracts, and requisite financial reconciliation that are negotiated across specialty management products using those medical outcomes as a basis for evaluation. This role requires extensive experience working with medical benefit claims and survey data, as well as deep experience in translating clinical data into significant client outcomes. Previous leadership developing or supporting risk-based contracting supported by financial and clinical outcomes is also highly desirable. In this role you will interact closely with senior leadership to set strategic direction, as well as with product development, sales, underwriting, analytics, clinical affairs and legal to ensure that program metrics and guarantees are thoughtfully established, reported, reconciled and presented to clients with the highest standards of ethical and professional conduct. In addition, you will supervise a team of client analytics (client engagement) staff who are responsible for supporting the key analytic value measurement, translation, and delivery to external clients for the Accordant Care Management program, as well as other CVS Specialty programs and services as assigned.

- Provides strategic and analytic oversight, including methodological input, for customer financial settlements and reconciliations, and ensures company is successfully reserving for various risk arrangements, working closely with leadership, product, and business partners.

- Provides leadership and mentorship for engaging clients across all assigned specialty drug and patient management programs. Collaboration is paramount to success with key partners from sales, legal, product development, underwriting, information technology, analytics, operations, account management, and senior management.

- Leads and develops a team of approximately six (6) externally focused (client/account engaging) analytic team members.

- Effectively communicates program outcomes to internal and external customers, while working collaboratively with clients to address methodologies and other questions.

- Optimally interacts with senior management, outside consultants, other employees and any other persons to forward and represent the needs of the department.

- Coordinates development and ongoing refinement of specific contractual language to support program level guarantees in client agreements and RFP responses.

- Leads all aspects of development of necessary tracking documents to collect and communicate contractual guarantees, key achievements, and program outcomes.

- Coordinates creation and implementation of client-focused tools and deliverables that elevate the impact and insight of CVS Specialty’s suite of health and cost management products.

Required Qualifications
- 8+ years experience in healthcare

- 5+ years (deep experience) in the analysis and communication of costs and outcomes utilizing observational research methods and medical benefit data.

- 3+ years with leadership/accountability for an analytics function

- A minimum of 3 years managing client engagement activities, ideally within the healthcare payer and/or employer space

- Travel (can be up to 40%) may require but is not limited to flights, overnight stays, local travel, travel on short notice and other travel deemed necessary by the Company.

Preferred Qualifications
- Previous healthcare consulting experience.

- Outstanding problem-solver with high levels of intellectual curiosity.

- Experience and expertise in various analytic methods for evaluation of clinical programs

- Excellent writing and presentation skills - able to clearly communicate methodologies and results, as well as ability to engage in deep substantive problem solving with financial analysts

- Outstanding interpersonal and influencing skills..

- Strong people management skills who thrives in a bold environment, including a willingness to challenge the status quo

- Consensus builder

- Documented success in leading and developing a team of mix-level and mixed purpose individual contributors.

- Strong MS Excel and MS Access skills.

- Bachelors degree required

- Advanced degree in Business, Epidemiology, Biostatistics, Policy, or Health Care Administration preferred.

Business Overview
It’s a new day in health care.

Combining CVS Health and Aetna was a transformative moment for our company and our industry, establishing CVS Health as the nation’s premier health innovation company. Through our health services, insurance plans and community pharmacists, we’re pioneering a bold new approach to total health. As a CVS Health colleague, you’ll be at the center of it all.

We offer a diverse work experience that empowers colleagues for career success. In addition to skill and experience, we also seek to attract and retain colleagues whose beliefs and behaviors are in alignment with our core values of collaboration, innovation, caring, integrity and accountability.

CVS Health is an equal opportunity/affirmative action employer. Gender/Ethnicity/Disability/Protected Veteran - we highly value and are committed to all forms of diversity in the workplace. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT. We provide reasonable accommodations to qualified individuals with disabilities. If you require assistance to apply for this job, please contact our Advice and Counsel Reasonable Accommodations team. Please note that we only accept applications for employment via this site.

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Application Instructions

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