Credentialing Manager

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. As a Senior Manager of Provider Performance, your role is pivotal in guiding healthcare providers toward achieving optimal outcomes in value-based care, ultimately improving patient health and well-being while effectively managing costs. Critical will be developing and implementing strategic initiatives to increase provider readiness from traditional fee‑for‑service models to value-based care models. Here's an overview of the responsibilities and key skills associated with this role: Core Responsibilities 1. Performance Analysis: Conduct in-depth analysis of contractual performance metrics related to value-based care, including utilization measures, benchmarking, cost-effectiveness, and patient outcomes. 2. Data Interpretation: Interpret and translate complex data into actionable insights for healthcare providers, helping them understand and improve their performance. 3. Financial Management: Monitor financial performance related to value-based care contracts and identify opportunities for cost savings, risk adjustment and revenue enhancement. 4. Patient Engagement: Develop strategies to actively involve patients in their care and treatment plans. Implement patient education programs to promote health and prevent avoidable healthcare utilization. Provide constructive feedback and coaching to healthcare providers, offering guidance on how to enhance their practices to align with value-based care goals. 5. Technology Utilization: Evaluate and recommend technology solutions that support value-based care initiatives, including electronic health record (EHR) optimization and other relevant tools. Identify and implement innovative technologies and solutions that support value-based care delivery and improve patient outcomes. 6. Educational Support: Develop and deliver training programs to educate healthcare providers and staff on best practices in value-based care delivery, reporting suite, and program goals. 7. Risk Stratification: Assist in the development and implementation of risk stratification models to identify high-risk patients and tailor care interventions accordingly. 8. Patient Engagement Strategies: Collaborate on the development of strategies to actively engage patients in their care, promoting preventive measures and improving overall health outcomes. Key Skills 1. Analytical Skills: Proficient in analyzing healthcare data to identify patterns, trends, and areas for improvement. 2. Communication Skills: Effective communication skills to convey complex healthcare data and insights to diverse audiences. Ability to independently facilitate meetings with executive stakeholders Report on quarterly performance, internally and externally. 3. Problem-Solving: Strong problem-solving skills to address challenges and barriers to successful value-based care implementation. 4. Interpersonal Skills: Ability to build relationships and collaborate with healthcare providers, administrators, and other stakeholders 5. Knowledge of Value-Based Care Models: In-depth understanding of various value-based care models and their implications on healthcare delivery. 6. Change Management: Skill in managing and facilitating change within healthcare organizations. Routine operational huddles will be mandated to ensure ancillary departments have ongoing intervention 7. Technology Proficiency: Familiarity with healthcare information systems and technologies supporting value-based care. 8. Educational Facilitation: Ability to develop and deliver educational programs to diverse healthcare audiences Provide education and training programs for internal staff, including healthcare providers and administrative teams, to ensure a smooth transition to value-based care. Qualifications Bachelor's degree or commensurate work experience in consulting, business administration, or economics. 5+ years of experience in healthcare data analytics, administration, or a related role. In-depth knowledge of healthcare regulations, value-based care, and performance metrics. Strong analytical and problem-solving skills, with the ability to interpret complex data sets and identify improvement opportunities. Excellent communication and interpersonal skills to collaborate effectively with providers, team members, and stakeholders at all levels. Proven experience in designing and delivering training programs or educational initiatives. Proficiency in data management and analysis tools, such as Excel or data visualization software. Detail-oriented, organized, and able to manage multiple projects simultaneously. Ability to work independently, demonstrate initiative, and drive results in a fast-paced environment. Position is remote - secure home network required and familiar with Microsoft Office products and VPN Familiarity with electronic health record systems and healthcare information technology. - NOT REQUIRED, BUT NICE TO HAVE Pay Range The typical pay range for this role is: $67,900.00 - $199,144.00 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. 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. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We anticipate the application window for this opening will close on: 08/15/2026 #J-18808-Ljbffr