New Jersey Medicaid Lead Director, Network Management

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 Summary
The NJ Medicaid Lead Director, Network Management is accountable for designing conceptual models, initiative planning, and negotiating Medicaid value based agreements with New Jersey providers, including health systems, clinically integrated networks, IPAs, FQHCs and others, in accordance with company standards in order to maintain and enhance Medicaid provider networks, while working cross functionally to ensure consistency with all contracting strategies and meeting and exceeding accessibility, quality, compliance, regulatory, and financial goals and cost initiatives. 

Responsibilities include, but not limited to:

• Manages Medicaid contract performance and drives the development and implementation of contract relationships in support of business strategies.

• 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.

• May optimize interaction with assigned vendors/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.

• Strong communication, critical thinking, problem resolution, interpersonal skills, organizational and time management skills.

• Team player with proven ability to develop strong working relationships within a fast-paced, matrix organization. 

• Demonstrated ability to influence and collaboration with internal and external partners via strong written and verbal communications

Required Qualifications

• Minimum 7+ years related experience and expert level negotiation skills with successful track record negotiating contracts with large or complex national vendors/providers.

• Proven working knowledge of provider financial issues and competitor strategies, complex contracting options, financial/contracting arrangements, and regulatory requirements.

• Demonstrated ability to identify and manage initiatives that improve total medical cost and quality. 

• Health Plan/Payer or Provider Systems experience

Preferred Qualifications

• Medicaid regulatory experience

• Medicaid contracting & setup experience.

• Experienced in provider/vendor contract set up in core Aetna Medicaid systems (QNXT experience).

• Experience with New Jersey providers

• Resides in New Jersey

Education

Bachelor's degree or equivalent professional work experience.

Pay Range

The typical pay range for this role is:

$100,000.00 - $231,500.00

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. 
 
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