Lead Director, Network Cost Management Solutions and Payment Integrity Remote

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

Leads team of approximately 6 employees and overall scope of 25-30 to develop enterprise-wide solutions (medical cost containment and payment integrity) to address business problems, resulting in lower cost of care for clients and members enabling the organization to be competitive in the marketplace and effectively serve its customers.

Responsible for the out of network product portfolio, market analysis, creative and new solutions, pricing and profitability strategies, measures performance and ensures regulatory compliance to achieve business objectives and drive growth in the competitive TPA market. Collaborates across the organization to optimize the achievement of strategic business objectives to include profitable growth and improved organizational effectiveness.

**Candidates may reside anywhere in the US.

Requirements

• Responsible for out of network (cost management) products, savings, revenue, financial results and commitments.

• Works closely with sales, account management, and operations to resolve any problems and ensure client, broker, consultant and provider needs are being met.

• Evaluates new business opportunities, fosters innovation, and adapts strategies to meet evolving market conditions and industry trends.

• Explores opportunities for digital transformation, process optimization, and the adoption of new technologies to enhance operational efficiency, total cost of care savings and plan outcomes.

• Contributes to planning budgets for strategic initiatives and programs that drive organizational growth, operational effectiveness, and innovation.

• Contributes by conducting market research, analyzing customer needs, and monitoring industry trends to identify market opportunities, customer pain points, and competitive dynamics.

• Communicates with cross-functional teams, including operations, sales, regulatory/compliance, and finance, to ensure alignment of product strategy, execution, and go-to-market plans.

• Identifies and pursues new business opportunities to drive growth and revenue.

• Provides regular reports and updates regarding business operations, strategic initiatives, financial performance, and key achievements

• Provides leadership, mentorship, and guidance to the team, fostering a culture of collaboration, innovation, and continuous learning.

Background/Experience Required

• Minimum 8 years in healthcare industry experience in product, finance, operations, network/out of network, payment integrity, and/or related disciplines

• Proven leadership/management experience

• Market exposure to account management, sales, brokers, and clients

• Proven ability to analyze and interpret complex data sets to develop actionable strategies.

• Strong communication skills, including experience presenting to senior leadership.

• Strong analytical abilities with proficiency in data interpretation and financial modeling.

• Ability to influence and drive change within a complex organizational structure.

• Growth mindset, creative solutions, problem solver, quick decision maker

• Self-motivator, works well independently

• Strong leadership, collaboration and teamwork

Education

• Bachelor's degree preferred/specialized training/relevant professional qualification

Pay Range

The typical pay range for this role is:

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. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.