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Position Summary
The Kentucky Network Lead Director will be accountable for developing strategic partnerships for the Kentucky Medicaid Health Plan. 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 Medicaid.
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 10 years related experience and expert level negotiation skills with successful track record negotiating contracts with large or complex provider systems.
Demonstrated experience in Medicaid provider contracting, including negotiating, executing, and managing agreements with hospitals, physician groups, and ancillary providers
Hands-on experience with Behavioral Health (BH) network development and contracting, including providers across inpatient, outpatient, and community-based settings
Proven ability to manage the end-to-end contracting lifecycle (negotiation, redlining, implementation, and ongoing relationship management)
Strong knowledge of Medicaid regulations, state requirements, and network adequacy standards, with the ability to ensure compliance across market
Experience developing or supporting value-based arrangements and reimbursement models within Medicaid and Behavioral Health populations
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.
Previous experience with leading a team.
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, 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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Skills Required
- Minimum of 10 years related experience
- Expert level negotiation skills
- Experience in Medicaid provider contracting
- Experience with Behavioral Health network development
- Strong knowledge of Medicaid regulations
- Experience with value-based arrangements and reimbursement models
- Ability to build strategic relationships
- Experience presenting complex information
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
