Lead Director, Network Management - Metro NY

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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
Provides strategic leadership and oversight for network management and provider relations. Develops and implements network strategies, manages provider contracts and negotiations, monitors provider performance metrics, leads dispute resolution processes, and collaborates with key stakeholders to drive network growth and ensure high-quality provider relationships. 

WHAT YOU WILL DO:

·         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. 

·         Develops training sessions and communicates updates related to network management, utilization management, claims processing, and other relevant topics. 

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

**Candidates must be within reasonable commutable distance to Metro New York

Required Qualifications

·         10+ years of experience and expert level negotiation skills with successful track record negotiating contracts with large or complex provider systems. Command of financials and pricing strategies.

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

·         Health plan/payer or large provider systems knowledge and experience

·         Proven analytical and financial skills.

·         Adept at execution and delivery (planning, delivering, and supporting) 

·         Mastery of problem solving and decision-making skills.  

Preferred Qualifications

·         Development of value-based relationships

·         Experience with providers in New York

Education

·         bachelor’s degree preferred/specialized training/relevant professional qualification.

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, geography and other relevant factors.  This position is elig