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