Lead Director, Network Management
Job Description:
- Design conceptual models and plan initiatives
- Negotiate Commercial/Medicare Advantage agreements with Texas providers, including health systems, clinically integrated networks, IPAs, FQHCs and others
- Maintain and enhance Commercial/Medicare Advantage provider networks
- Work cross-functionally to ensure consistency with contracting strategies
- Meet and exceed accessibility, quality, compliance, regulatory, financial, and cost initiative goals
Requirements:
- 10+ years related experience
- Expert-level negotiation skills with a successful track record negotiating contracts with large or complex national vendors/providers
- Working knowledge of provider financial issues and competitor strategies
- Knowledge of complex contracting options, financial/contracting arrangements, and regulatory requirements
- Ability to identify and manage initiatives that improve total medical cost and quality
- Health Plan/Payer or Provider Systems experience
- Must reside in Texas
- Bachelor's degree or equivalent professional work experience
- Preferred: Commercial/Medicare Advantage Fee-for-Service contract experience
- Preferred: Commercial/Medicare Advantage regulatory experience
- Preferred: Commercial/Medicare Advantage contracting and setup experience
- Preferred: Working knowledge of Value-Based Contracting
Benefits:
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being
- CVS Health bonus, commission or short-term incentive program
- Equity award program
