Executive Director, Network Management - Heartland Territory

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

At Aetna, our health benefits business, we are committed to helping our members achieve their best health in an affordable, convenient, and comprehensive manner. Combining the assets of our health insurance products and services with CVS Health’s unrivaled presence in local communities and their pharmacy benefits management capabilities, we’re joining members on their path to better health and transforming the health care landscape in new and exciting ways every day.

Aetna is recruiting for an Executive Director, Network Management who provides strategic leadership and oversight for network management and provider relations within the Heartland market (Missouri, Illinois, Colorado, Iowa, Kansas, Nebraska, North Dakota and South Dakota). This leader will develop and implement network strategies, manage provider contracts and negotiations, monitor provider performance metrics, lead dispute resolution processes, and collaborate with key stakeholders to drive network growth and ensure high-quality provider relationships.

Major Responsibilities

• 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.

• Communicates findings to executive leadership and stakeholders, identifying opportunities for improvement and cost containment.

• Manages operational aspects of the team, subsequently implementing workforce and succession plans to meet business goals and objectives.

• Guides management for individual performance evaluations aimed to provide critical feedback for skills development and depth of work area experience.

Required Qualifications

The candidate will have a strong work ethic, be a self-starter, and be able to be highly productive in a dynamic, collaborative environment. This position offers broad exposure to all aspects of the company’s business, as well as significant interaction with all the business leaders. The candidate will be expected to have the following key attributes:

• 12+ years of experience in managed care; leading and managing teams.

• Experience contracting with providers and hospital systems.

• Strong analytical skills including root cause analysis.

• Ability to think strategically.

• Skilled at collaborating and working across a matrixed organization.

• Expertise in market level management, cost drivers and levers, and knowledge of economic, regulatory and marketplace issues.

• Possess exceptional leadership skills and transformational experience with a proven track record of delivering results.  

Education

• Bachelor's degree required/specialized training/relevant professional qualification.

Pay Range

The typical pay range for this role is:

$131,500.00 - $303,195.00

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. 
 

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