Lead Director – Medical Pharmacy Network

This is a fully remote position, open to applicants in Idaho, +2 more states.

📋 Description

• Drive the strategy and enhance performance for medical drug reimbursement across hospitals, health systems, and regional provider partners.

• Equip market teams with guidance on contracting, analytics, and best practices to enhance cost, quality, and access outcomes.

• Cultivate market network contract relationships and assist with agreements and negotiations involving health systems, hospitals, and regional provider groups.

• Harmonize medical pharmacy strategy with National Ancillary Network and Value-Based Care teams.

• Formulate strategic retail network initiatives and plans by examining market trends, competitive advantages, and opportunities to boost network effectiveness and efficiency.

• Define programs that integrate provider network strategy with business objectives in collaboration with operations, marketing, and finance.

• Oversee systems that monitor performance within the medical pharmacy and infusion provider network; analyze KPIs and pinpoint areas for improvement.

• Engage with external healthcare organizations and insurance providers to forge partnerships and collaborative agreements.

• Align retail provider network strategies with legal and regulatory frameworks, ensuring compliance with health regulations and standards.

• Provide counsel to senior management and stakeholders regarding provider network performance, patient expectations and outcomes, as well as financial metrics and targets.

• Create strategies for retail network performance and collaborate with market leaders to fulfill business plan requirements and team objectives.

⛳️ Requirements

• A minimum of 10 years of experience in health plan operations, network contracting, or provider-facing contracting environments.

• At least 3 years of experience in a health plan setting, with insights into payer operations and healthcare administration.

• Proficiency in translating complex contracting, financial, and operational information into concise narratives suitable for executive-level audiences.

• Capability to critically assess contract terms, reimbursement structures, and business proposals.

• Ability to challenge unfavorable provisions, mitigate risks, safeguard organizational interests, and uphold strategic objectives.

• Understanding of medical pharmacy reimbursement and outpatient reimbursement models, taking into account payer and provider considerations.

• Experience with health system and hospital network contracts is preferred.

• Contracting experience with infusion, medical pharmacy arrangements, and/or value-based care is preferred.

• A Bachelor's degree is preferred, or an equivalent combination of education and work experience.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program in addition to the base pay range.

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

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Other resources supporting physical, emotional, and financial well-being, based on eligibility.