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CVS Health Lead Director, Network Management (Michigan)(Medicaid) in Council Bluffs, Iowa

Job Description

Remote opportunity for a Michigan based network professional. Relocation is available.The Lead Director, leads a team of Network Managers, Consultants and Contract Negotiators who design, develop, manage and/or implement strategic network configurations and effective managed care network relationships.Oversees the development of programs to maintain and enhance collaborative provider relationships andoperational effectiveness. Manages the activities of the network development team, including effective strategies to build progressive provider partners and relationships.Maintains accountability for related compliance,quality and financial goals. Effectively negotiates the most complex, competitive contractual relationships with providers according to prescribed financial guidelines with all provider types including at risk, IPA/IPO, hospital and large provider/provider groups. Ensures necessary review; oversee and support network filings in compliance with state and federal regulations.May include value-based agreements depending on market requirements.Accountable for cost arrangements and contract performance in support of network quality, availability and financial strategies to achieve P-Model, discounts and cost management goals.Ensures network coverage adequacy and implements action items to close gaps.Responsible for advancing the adoption of value-based payment models.May work with VBC Engagement managers to develop VBC arrangements and collaborative agreements.Develops and presents value proposition; presents the potential for network performance results in sales meetings or to external constituents.Analyzes data and is responsible for understanding medical cost issues and trends; collaborates with Medical Economics to monitor and identify scorable action plans; works closely with Population Health to enable and improve clinical outcomes.May oversee Network Relations teams that manage the service needs for providers including network/provider relations policy, recruitment, education and training, as well as improved workflows.

Required Qualifications

Medicaid knowledge in Michigan.Required to communicate w/internal/external parties by phone/in person; may require travel to offsite location.Resident in Michigan (relocation package is available).

COVID Requirements

COVID-19 Vaccination Requirement

CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

Preferred Qualifications

8 – 10 years related experience Related experience in health operations, network relations and development, command of financials and pricing strategies, and sales interface.Experience building and maintaining relationships with provider systems.A successful track record managing and negotiating major provider contracts In depth knowledge of various reimbursement structures and payment methodologies for both hospitals and providers/providers.Knowledge and experience with value based contracting and accountable care models.In-depth knowledge of managed care business, regulatory /legal requirements.Solid leadership skills, including staff development and talent management.


Bachelor's degree or equivalent work experience.MBA/Masters degree preferred

Business Overview

At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. 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.