Executive Director, Medicaid Provider Relations – Contracting

This is a fully remote position, open to applicants in New Jersey, +5 more states.

📋 Description

• Oversee provider relations and contracting efforts across various Medicaid markets within the Northeast Region.

• Establish uniform provider engagement standards and contracting methodologies while accommodating state-specific requirements.

• Formulate scalable provider strategies aimed at enhancing execution, operational efficiency, and the overall provider experience.

• Facilitate the sharing of best practices across markets to reinforce provider partnerships and boost network performance.

• Assist in intricate provider negotiations and contracting initiatives that span multiple markets or provider systems.

• Create regional dashboards and executive reports focusing on provider satisfaction, network health, and contracting results.

• Spearhead the development and implementation of Medicaid provider engagement and contracting strategies.

• Align initiatives with market priorities, growth targets, regulatory obligations, and business performance objectives.

• Act as a senior Network leader and collaborator with market, regional, compliance, operations, clinical, and government programs leadership.

• Cultivate and sustain relationships with provider organizations, health systems, physician groups, ancillary providers, behavioral health partners, and community-based organizations.

• Supervise provider outreach, education, issue resolution, escalation management, and ongoing engagement.

• Leverage provider feedback and market insights to enhance provider experience and minimize avoidable friction.

• Provide executive oversight for Medicaid provider contracting strategies, negotiation support, and network development priorities.

• Ensure that network adequacy standards are achieved and maintained.

• Guarantee compliance with state Medicaid contracts, regulatory requirements, audit standards, and internal policies.

• Collaborate with Compliance, Legal, and Government Programs teams on regulatory matters, corrective actions, and risk mitigation.

• Maintain preparedness for state reviews, audits, reporting requests, and network adequacy validations.

• Assess network health, provider satisfaction, access, issue trends, and operational effectiveness using data and reporting.

• Develop executive-level reports, recommendations, and business updates for senior leadership.

• Address complex provider issues related to access, claims, operations, reimbursement, and service experience.

• Mentor and guide provider-facing and contracting staff through performance expectations, coaching, and talent development.

• Promote a collaborative, inclusive, market-focused culture centered on execution and continuous enhancement.

• Assist in workforce planning, succession planning, and change leadership as operations transition into local market frameworks.

⛳️ Requirements

• Must reside in Virginia, West Virginia, Maryland, Pennsylvania, New Jersey, or New York.

• 10+ years of progressive experience in Medicaid network management, provider relations, provider contracting, managed care, or a related healthcare leadership role.

• 5+ years of leadership experience overseeing provider-facing, contracting, or network management teams.

• Proven experience working with Medicaid programs and navigating intricate state regulatory environments.

• Demonstrated ability to influence senior leaders, manage complex provider relationships, and drive execution within a matrixed organization.

• Strong analytical, communication, negotiation, and relationship-building abilities.

• Bachelor’s degree or equivalent.

• Preferred: Experience in leading provider relations and contracting functions across multiple Medicaid states.

• Preferred: Comprehensive understanding of multi-state Medicaid operations, regulatory requirements, and market variations.

• Preferred: Experience in managing geographically dispersed teams through changes or operational model transformations.

• Preferred: Proven ability to establish common standards while maintaining necessary local market flexibility.

🏝️ Benefits

• CVS Health bonus, commission or short-term incentive program.

• Award target in the company’s equity award program.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being.