Job Description
Candidates must reside in VA with commutable distance to Richmond office location or must be able and willing to relocate to VA. Candidates may have an opportunity for relocation assistance.
The Regional Lead Director, Network Management VBC-Northeast Region is accountable for working with our strategic provider partners to develop innovative value-based solutions to meet total cost and quality goals for our Medicaid businesses. This role leads a team of approximately 3 employees.
-Responsible for designing conceptual models, initiative planning, and negotiating high value/risk contracts with the most complex and challenging, market/region/national, largest group/system or highest value/volume of spend providers in accordance with company standards in order to maintain and enhance provider networks, while working cross functionally to ensure consistency with all contracting strategies and meeting and exceeding accessibility, quality, compliance, and financial goals and cost initiatives.
-Drives or guides development of holistic solutions or strategic plans negotiates and executes contracts with the most complex, market /region/national, largest group/system or highest value/volume of spend providers with significant financial implications.
-Works with Territory Performance Team to manage contract performance and drives the development and implementation of value based contract relationships in support of business strategies.
-Recruits providers as needed to ensure attainment of network expansion and adequacy targets. Accountable for cost arrangements within defined groups.
-Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities.
-Responsible for identifying and managing cost issues and collaborating cross functionally 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. May optimize interaction with assigned providers and internal business partners to facilitate relationships and ensure provider needs are met.
-Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.
Pay Range
The typical pay range for this role is:
Minimum: 100,000
Maximum: 221,000
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications
-Resides commutable distance to Richmond office location or willing to relocate to commutable distance to Richmond office location
– Minimum 8+ years of related experience and expert level negotiation skills with successful track record negotiating contracts with large or complex provider systems.
-Experience developing, negotiating, executing and managing value-based arrangements. Strong understanding of value-based metrics and analytics.
-Must understand strategy around risk arrangements
-Proven working knowledge of provider financial issues and competitor strategies, complex contracting options, financial/contracting arrangements and regulatory requirements.
-Experience leading a team
-Strong communication, critical thinking, problem resolution and interpersonal skills.
Preferred Qualifications
-Project and/or Program Management
-Provider Relations for VBS
Education
Bachelor’s Degree or equivalent experience
Business Overview
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. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.