Lead Director, Provider Network Management - Metro NY - CVS Health : Job Details

Bring your heart to CVS Health. Every one of us at CVS Health shares 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. We want 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.Position SummaryProvides strategic leadership and oversight for network management and provider relations. Develops and implements network strategies, manages provider contracts and negotiations, monitors provider performance metrics, leads dispute resolution processes, and collaborates with key stakeholders to drive network growth and ensure high-quality provider relationships.WHAT YOU WILL DO:* Oversees key Network Management contracting activities, including negotiating fee schedules, reimbursement rates, and contract terms and conditions.* 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.* 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.* Manages the performance of network providers, including tracking key performance indicators, analyzing provider performance data, and implementing performance improvement initiatives.* Conducts market analysis, assesses competitive landscapes, and makes recommendations for network expansion strategies.* Develops training sessions and communicates updates related to network management, utilization management, claims processing, and other relevant topics.* Communicates findings to executive leadership and stakeholders, identifying opportunities for improvement and cost containment.Candidates must be within reasonable commutable distance to Metro New YorkRequired Qualifications* 10+ years of experience and expert level negotiation skills with successful track record negotiating contracts with large or complex provider systems. Command of financials and pricing strategies.* 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.* Adept at execution and delivery (planning, delivering, and supporting)* Mastery of problem solving and decision-making skills.Preferred Qualifications* Development of value-based relationships* Experience with providers in New YorkEducation* bachelor's degree preferred/specialized training/relevant professional qualification.Pay RangeThe typical pay range for this role is:$100,000.00 - $231,540.00This 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.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. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.For more detailed information on available benefits, please visit Benefits | CVS HealthWe anticipate the application window for this opening will close on: 12/24/2024Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.