[Remote] Lead Director, Network Management (Northern California)

Note: The job is a remote job and is open to candidates in USA. CVS Health is committed to building a world of health around every individual by creating a more connected and compassionate health experience. The Lead Director is responsible for developing strategic partnerships to ensure competitive networks and managing complex provider contracts to enhance provider relationships and financial performance.

Responsibilities

• Key focus on building strong relationships with providers and develop / execute on contract strategies that yield market leading discount bringing best in class cost positions for Aetna as well as value-based partners to improve the quality and financial performance of Aetna's networks for its members
• Responsibilities include leading a negotiation Team focused on Health Systems, Hospitals and Medical Groups as well as the management of contract performance with key focus on provider engagement and financial results in accordance with Company standards (examples – pModel, SAI Targets…)
• Recruit providers as needed to ensure attainment of network expansion and adequacy targets
• Collaborate cross-functionally with internal Teams to manage provider compensation and pricing development activities, submission of contractual information, and the review and analysis of reports as part of the negotiation and reimbursement modeling activities. Accountable for cost arrangements within defined within these defined workgroups
• Responsible for collaborating with cross functional Team to execute significant cost saving initiatives. Represents company with high visibility constituents, including customers and community groups
• Promotes collaboration with internal partners. Evaluates, helps formulate, and implements the provider network strategic plans to achieve contracting targets and manage medical costs through effective provider contracting to meet state contract and product requirements. Collaborates with internal partners to assess effectiveness of tactical plan in managing costs
• Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information
• Strong communication, critical thinking, problem resolution and interpersonal skills. Exceptional Customer Service Skills

Skills

• 10+ years related experience, including expert level negotiation skills with successful track record negotiating contracts with large or complex provider systems. Command of financials and pricing strategies
• Ability to collaborate with a team of Contract Negotiators and Sr. Network Managers to ensure cost effective and quality provider agreements
• Proven working knowledge of provider financial issues and competitor strategies, complex contracting options, financial/contracting arrangements, and regulatory requirements
• Health plan/payer or large provider systems knowledge and experience
• Proven analytical and financial skills. Must be proficient with Microsoft Office Software (Excel, Power Point and Word)
• Bachelor's Degree or equivalent combination of education and experience
• Development of complex contracting relationships including FFS/Value Based/Capitation
• Reside in Northern California and have experience working with providers in this market
• Experience with Aetna systems including (Strategic Contract Manager, EPDB, Quickbase, Claims Systems-HRP-ACAS
• Experience with ancillary provider types (Durable Medical Equipment, Home Health Care, Home Infusion)

Benefits

• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources, based on eligibility

Company Overview

• CVS Health is a health solutions company that provides an integrated healthcare services to its members. It was founded in 1963, and is headquartered in Woonsocket, Rhode Island, USA, with a workforce of 10001+ employees. Its website is https://www.cvshealth.com/.

Company H1B Sponsorship

• CVS Health has a track record of offering H1B sponsorships, with 1 in 2022. Please note that this does not guarantee sponsorship for this specific role.