Lead Director, Provider Network Management - Strategic Healthcare Leader

Join the CVS Health Team: Lead Director, Provider Network Management

About CVS Health

At CVS Health, we're driven by a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors support this purpose, empowering everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient, and affordable.

Job Summary

We're seeking a highly experienced and strategic leader to join our team as a Lead Director, Provider Network Management. As a key member of our leadership team, you will provide strategic leadership and oversight for network management and provider relations. You will develop and implement network strategies, manage provider contracts and negotiations, monitor provider performance metrics, lead dispute resolution processes, and collaborate with key stakeholders to drive network growth and ensure high-quality provider relationships.

Key Responsibilities

• Network Development and Management: Oversees key Network Management contracting activities, including negotiating fee schedules, reimbursement rates, and contract terms and conditions.
• Provider Network Expansion: Controls the development and expansion of the company's provider network by evaluating potential network providers, negotiating contracts, and establishing relationships with healthcare providers to ensure a comprehensive and high-quality network.
• Network Performance Optimization: Contributes to optimizing the network's performance and effectiveness by analyzing network data, utilization patterns, and market trends to identify opportunities for network enhancements, cost savings, and improved access to care.
• Provider Performance Management: Manages the performance of network providers, including tracking key performance indicators, analyzing provider performance data, and implementing performance improvement initiatives.
• Market Analysis and Recommendations: Conducts market analysis, assesses competitive landscapes, and makes recommendations for network expansion strategies.
• Training and Communication: Develops training sessions and communicates updates related to network management, utilization management, claims processing, and other relevant topics.
• Executive Leadership and Stakeholder Engagement: Communicates findings to executive leadership and stakeholders, identifying opportunities for improvement and cost containment.

Requirements and Qualifications

Essential Qualifications:

• Experience: 10+ years of experience in a related field with expert-level negotiation skills and a successful track record negotiating contracts with large or complex provider systems.
• Financial Acumen: Command of financials and pricing strategies, as well as working knowledge of provider financial issues and competitor strategies.
• Analytical and Problem-Solving Skills: Proven analytical and financial skills, with mastery of problem-solving and decision-making skills.
• Health Plan/Payer or Large Provider Systems Knowledge: Health plan/payer or large provider systems knowledge and experience.

Preferred Qualifications:

• Value-Based Relationships: Experience with development of value-based relationships.
• New York Provider Experience: Experience with providers in New York.

Education and Training

Bachelor's degree preferred, with specialized training or relevant professional qualification.

Compensation and Benefits

The typical pay range for this role is:

• $100,000.00 - $231,540.00 per year

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long-term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year.

Career Growth Opportunities and Learning Benefits

At CVS Health, we're committed to helping our colleagues grow and develop their skills. We offer:

• Training and Development Programs: Comprehensive training programs to help you develop your skills and advance in your career.
• Mentorship Opportunities: Opportunities to work with experienced leaders and mentors who can help guide you in your career.
• Education Assistance: Education assistance programs to help you pursue your educational goals.
• Career Advancement Opportunities: Opportunities to advance in your career and take on new challenges.

Work Environment and Company Culture

At CVS Health, we're proud of our company culture and work environment. We offer:

• Remote Work Options: Flexible work arrangements, including remote work options.
• Collaborative Work Environment: A collaborative and dynamic work environment that encourages innovation and teamwork.
• Diverse and Inclusive Culture: A diverse and inclusive culture that values and respects all colleagues.

Why Join CVS Health?

We're a company that puts our heart into caring for our colleagues and our communities. We offer:

• Meaningful Work: Meaningful work that makes a difference in the lives of our customers.
• Opportunities for Growth: Opportunities for growth and development.
• Competitive Compensation and Benefits: Competitive compensation and benefits.
• Dynamic Work Environment: A dynamic and collaborative work environment.

How to Apply

If you're a motivated and experienced leader looking for a new challenge, we encourage you to apply for this exciting opportunity. Please submit your application, including your resume and cover letter, to:

Don't miss this opportunity to join our team and make a difference in the lives of our customers. Apply today!