Lead Director, Network Management (Pacific Northwest)

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.

**Strong preference for candidate to sit in the Pacific Northwest, however would be open to candidates in the Pacific Time Zone and Mountain Time Zone.**

**This is an individual contributor**

Position Summary

The Lead Director will be accountable for developing strategic partnerships to ensure Aetna has market leading discount and cost positions and high value, competitive networks. Strong focus on designing conceptual models, initiative planning, and negotiating high value contracts with the most complex and challenging hospital systems, integrated delivery systems and large groups 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. Contracting responsibilities include Medicare and Commercial.

• Key focus on building strong relationships with providers as well as developing and executing contract strategies and yield market leading discount and cost positions for Aetna as well as value-based relationships that improve the quality and financial performance of Aetna's networks for its members. Responsibilities include negotiation and management of various value based payment models and management of contract performance associated with these models with key focus on provider engagement.

• Recruit 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.

• Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.

• Helps mentor and develop others within the department by providing shadowing opportunities and acting as a subject matter expert.

Required Qualifications

• A minimum of 8 years related experience and expert level negotiation skills with successful track record negotiating contracts with large or complex provider systems. 

• Demonstrated knowledge of value-based contracting structures, including negotiation and implementation of agreements that align cost, quality, and performance outcomes across stakeholders.

• Experience with Medicare, Commercial contracting and various reimbursement methodologies.

• Demonstrated ability to build, manage, and grow strategic relationships that advance long-term organizational goals.

• Experience presenting complex information to groups in a clear, concise, and persuasive manner, adapting style and content to audience needs.

Preferred Qualifications

• Proven working knowledge of provider financial issues and competitor strategies.

• Strong preference to have relationships with large health systems in Oregon, Washington and Idaho.

Education

• Bachelor’s Degree preferred or equivalent combination of education and experience

 

Pay Range

The typical pay range for this role is:

$100,000.00 - $231,540.00

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, ge