Lead Director, Value-Based Contracting (Central Region)

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.

Position Summary

The Lead Director of Value-Based Contracting is responsible for establishing and maintaining productive value-based relationships with key network providers. Responsible to develop and manage the Value-based Network for a Region as outlined below:

• Accountable for building strategic relationships with our provider partners to develop innovative value-based solutions to meet total cost and quality goals.

• Responsible for developing alternative payment models, identifying and planning new initiatives, and negotiating high value/risk contracts with the most complex arrangement structures, which requires:

  • understanding providers’ volume and cost structure

  • working cross functionally to identify the levers and critical negotiation points

  • aligning negotiation strategies and tactics with network accessibility, quality, compliance, and financial performance goals

• In charge of complete value-based contracting cycle from planning, creating documents, negotiation and loading of executed arrangements.

• Works with Performance team, Clinical Transformation team, VBS Analytics team and other key internal teams to develop a value-based strategic plan and oversee contract performance with targeted provider groups to ensure we meet objectives for value-based provider agreements.

• Evaluates, helps formulate, and implements network strategic plans to achieve value-based contracting targets and manage medical costs through effective value-based contracting.

• Provide assistance and support to other departments, as needed, to obtain crucial or required information from providers, such as HEDIS, Credentialing, etc.

• Leads work and deliverables of complex projects/programs, through assessment to implementation, that may impact multiple processes, systems, functions, and products across all lines of business.

• Facilitates and attends external provider meetings and negotiations, as needed.

• Manage Value-Based ACO products (Aetna Whole Health local networks); this may include day-to-day management in addition to the contracting of ACO product deal terms.

• Assumes supervisory responsibilities for VBC contracting team members.

• Assists Executive Director, Provider Performance, in developing and driving strategies to achieve organizational goals.

• Serves as support and back-up to Executive Director, Provider Performance, as needed.

• Drives and monitors consistency and adherence to policies/protocols of department.

• Assists in identification and promotion of best practices within Team.

• Identifies training and/or educational needs within Team.

• Oversees training plan for new Team contracting colleagues. 

Required Qualifications

• 10+ years of related experience and comprehensive level of negotiating skills with successful track record negotiating value-based contracts with IPAs, large complex provider systems or groups, hospitals and large physician and risk bearing entities

• Experience developing executive summaries and identifying opportunities for mitigating medical cost trend

• Excellent analytical and problem-solving skills

• Strong communication, negotiation, and presentation skills

• Ability to work in a matrixed organization and gain consensus and share information to various interested parties

Preferred Qualifications

• Familiar with legal terms in the context of provider contracting

• Familiar with CMS Stars and HEDIS technical specifications and various measurable percentiles associated with the HEDIS measures

• Experience with Commercial, Medicare, and Individual Exchange contracting

• Able to apply system thinking when managing multiple provider value-based initiatives

• Strong financial modeling background

Education

• Bachelor’s degree preferred or a combination of professional work experience and education.

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 posit