[Remote] Executive Director, Network Management - Keystone Territory

Note: The job is a remote job and is open to candidates in USA. CVS Health is the nation’s leading health solutions company, dedicated to transforming health care. They are seeking an Executive Director, Network Management who will provide strategic leadership for network management and provider relations, develop network strategies, and manage provider contracts to enhance healthcare access and quality.

Responsibilities

• Overseeing key network management contracting activities, including negotiating fee schedules, reimbursement rates, and contract terms and conditions
• Controlling the development and expansion of the company's provider network by evaluating potential network providers, negotiating contracts, and establishing relationships with healthcare providers to ensure a comprehensive and high-quality network
• Contributing to optimizing the network's performance and effectiveness by analyzing network data, utilization patterns, and market trends to identify opportunities for network enhancements, cost savings, and improved access to care
• Managing the performance of network providers, including tracking key performance indicators, analyzing provider performance data, and implementing performance improvement initiatives
• Conducting market analysis, assessing competitive landscapes, and making recommendations for network expansion strategies
• Communicating findings to executive leadership and stakeholders, identifying opportunities for improvement and cost containment
• Managing operational aspects of the team, subsequently implementing workforce and succession plans to meet business goals and objectives
• Guiding management for individual performance evaluations aimed to provide critical feedback for skills development and depth of work area experience

Skills

• 10+ years of experience in managed care; leading and managing teams
• Experience contracting with providers and hospital systems within the territory
• Comprehensive understanding of hospital and physician financial issues and how to leverage technology to achieve quality and cost improvements for both payers and providers
• In-depth knowledge of various reimbursement structures and payment methodologies for both hospitals and physicians
• Comprehensive understanding of value-based strategies and population health management, and Aetna's related strategic initiatives
• Strong experience building and maintaining relationships with large hospitals/provider systems, integrated delivery systems and large physician groups
• Understands the regulatory environment and ensures contractual compliance with federal and state requirements
• Expertise in market level management, cost drivers and levers, and knowledge of economic, regulatory and marketplace issues
• Possess exceptional leadership skills and transformational experience with a proven track record of delivering results
• High ability to drive new strategies or initiatives in highly cross-functional environments
• Expertise with influencing and navigating a highly matrixed environment
• Effectively lead and motivate teams to ensure high standards of performance and outcomes
• Strong analytical and critical thinking skills. Focus on driving disciplined, fact-based decisions, and executing with discipline and urgency
• Success in moving from current traditional strategies to new, modified approaches championing change
• Person must reside within the market (PA or WV) or neighboring states with a willingness to travel within the market states
• Bachelor's degree is required

Benefits

• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

Company Overview

• CVS Health is a health solutions company that provides an integrated healthcare services to its members. It was founded in 1963, and is headquartered in Woonsocket, Rhode Island, USA, with a workforce of 10001+ employees. Its website is https://www.cvshealth.com/.

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