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 is accountable for developing strategic partnerships to ensure Aetna has market leading discount and cost positions and high value, competitive networks. Strong focus on designing conceptual models, initiative planning, and negotiating high value contracts with the most complex and challenging Providers in accordance with Company standards 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. Contract responsibilities include Medicare and Commercial.
Responsibilities include, but are not limited to:
- Key focus on building strong relationships with providers and develop / execute on contract strategies that yield market leading discount bringing best in class cost positions for Aetna as well as value-based partners to improve the quality and financial performance of Aetna's networks for its members.
- Responsibilities include leading a negotiation Team focused on Health Systems, Hospitals and Medical Groups as well as the management of contract performance with key focus on provider engagement and financial results in accordance with Company standards (examples – pModel, SAI Targets…).
- Recruit providers as needed to ensure attainment of network expansion and adequacy targets.
- Collaborate cross-functionally with internal Teams to manage provider compensation and pricing development activities, submission of contractual information, and the review and analysis of reports as part of the negotiation and reimbursement modeling activities. Accountable for cost arrangements within defined within these defined workgroups
- Responsible for collaborating with cross functional Team 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.
- Strong communication, critical thinking, problem resolution and interpersonal skills. Exceptional Customer Service Skills.
Required Qualifications
- 10+ years related experience, including expert level negotiation skills with successful track record negotiating contracts with large or complex provider systems. Command of financials and pricing strategies.
- Ability to collaborate with a team of Contract Negotiators and Sr. Network Managers to ensure cost effective and quality provider agreements.
- 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. Must be proficient with Microsoft Office Software (Excel, Power Point and Word)
Preferred Qualifications
- Development of complex contracting relationships including FFS/Value Based/Capitation
- Reside in Southern California and have experience working with providers in this market
- Experience with Aetna systems including (Strategic Contract Manager, EPDB, Quickbase, Claims Systems-HRP-ACAS
- Experience with ancillary provider types (Durable Medical Equipment, Home Health Care, Home Infusion)
Education
Bachelor’s Degree 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
- 10+ years related experience with expert-level negotiation skills and track record negotiating contracts with large or complex provider systems
- Command of financials and pricing strategies
- Ability to collaborate with a team of Contract Negotiators and Senior Network Managers
- Proven working knowledge of provider financial issues, 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
- Proficiency with Microsoft Office (Excel, PowerPoint, Word)
- Bachelor's degree or equivalent combination of education and experience
- Development of complex contracting relationships including FFS, Value-Based, Capitation
- Reside in Southern California and have experience working with providers in this market
- Experience with Aetna systems (Strategic Contract Manager, EPDB, Quickbase, Claims Systems-HRP-ACAS)
- Experience with ancillary provider types (Durable Medical Equipment, Home Health Care, Home Infusion)
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.
