Lead Director, Network Management

This is a fully remote position, open to applicants in Texas.

📋 Description

• Create conceptual models and strategize initiatives

• Negotiate agreements related to Commercial/Medicare Advantage with providers in Texas, such as health systems, clinically integrated networks, IPAs, FQHCs, and more

• Sustain and improve networks for Commercial/Medicare Advantage providers

• Collaborate across departments to ensure alignment with contracting strategies

• Achieve and surpass goals related to accessibility, quality, compliance, regulatory standards, financial performance, and cost initiatives

⛳️ Requirements

• Over 10 years of relevant experience

• Exceptional negotiation skills with a proven history of successfully negotiating contracts with large or intricate national vendors/providers

• Familiarity with provider financial matters and competitor strategies

• Understanding of complex contracting alternatives, financial/contractual arrangements, and regulatory standards

• Capability to identify and manage initiatives that enhance overall medical costs and quality

• Experience in Health Plan/Payer or Provider Systems

• Must be a resident of Texas

• Bachelor's degree or equivalent professional experience

• Preferred: Experience with Commercial/Medicare Advantage Fee-for-Service contracts

• Preferred: Experience with Commercial/Medicare Advantage regulatory matters

• Preferred: Experience in Commercial/Medicare Advantage contracting and setup

• Preferred: Understanding of Value-Based Contracting

🏝️ Benefits

• Medical coverage

• Dental coverage

• Vision coverage

• Paid time off

• Retirement savings options

• Wellness programs

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

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

• Equity award program