Lead Director, Network Management Value-Based Care

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.

**This person must sit in FL or LA**

Position Summary
This role will be accountable for the strategic alignment, operational success and performance management of assigned provider relationships with the most complex/high value initiatives and/or highest risk and revenue generating provider systems, network and value-based relationships. Ensures that assigned value based contract arrangements are functioning successfully and working to improve quality of care while reducing costs. Additionally, this position will include supervisory responsibilities for VBS Provider Performance team members.   

This role is strategically designed to provide dedicated leadership and oversight for Medicaid value-based care (VBC) initiatives across the Florida and Louisiana markets.  This position carries broad responsibility for the development, execution, and oversight of Medicaid focused value-based contracting and provider performance strategies within these two key markets.

Key Responsibilities:

• Provider Relationship Management - Understands the terms of the value based contract arrangements to answer questions/address issues. Responsible for establishing and maintaining productive, professional relationships. 

• Educates internal and external parties as needed to ensure compliance with contract terms and expectations 

• Coordinates and prepares for external provider meetings and ensures that the most impactful internal subject matter experts (clinical, pharmacy, financial, analytical, etc.) are utilized to optimize performance. (External meetings include JOCs, clinical meetings, Informatics discussions, contract reconciliations, etc.)  

• Assists with workflow development and strategies to integrate data and reporting 

• Works independently to manage relationships and identify/implement solutions to problems  

• Drives provider performance and partners with local market to ensure pathways to performance against business and team objectives  

• Drives improvement in deal performance for multiple lines of business, complex models, and/or advanced national provider partners 

• Leverages reporting/data to monitor contract performance against financial, clinical, cost and efficiency targets. Adept at identifying issues or trends in reporting.  

• Assumes supervisory responsibilities for VBS Provider Performance team members Identifies improvement opportunities. Provides strategy consultation on actions/tactics to make needed improvements 

• Assists Executive Director, Provider Performance, in developing and driving strategies to achieve organizational goals 

• Serves as support and back-up to Executive Director, Provider Performance, as needed 

• Drives and monitors consistency and adherence to policies/protocols of department 

• Assists in identification and promotion of best practices within Team 

• Identifies training and/or educational needs within Team 

• Oversees training plan for new Team colleagues  

Required Qualifications

• 10 years experience in a health plan, health system or provider organization, ACO / managed-care experience preferred 

• Experience directly managing people and/or Teams 

• Self-directed individual with independent problem-solving skills 

• Proven ability to interact with, influence and collaborate with internal and external stakeholders at all levels 

• Experience managing matrixed environment with ability to leverage internal business partners to complete tasks 

• Good interpersonal and communication skills 

• Knowledge of healthcare and insurance industry 

• Ability to form strong client relationships 

Preferred Qualifications

• Adept at collaboration and teamwork with both internal and external partners 

• Experience with Provider Contracting, Plan Design and Product Offerings 

Education

• Bachelor's degree preferred or a combination of professional work experience and education.

Pay Range

The typical pay range for this role is:

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. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

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.

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.