Executive Director, Network Operations - First Health

CVS Health

3d

About The Position

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position Summary First Health is a large, national Preferred Provider Organization (PPO) network owned by Aetna, which provides members access to discounted healthcare services from a broad network of doctors, hospitals, and other providers across the United States. While it is owned by Aetna, First Health functions as a separate subsidiary, specializing in connecting its payer clients and their members to a nationwide network of doctors and facilities at negotiated rates to help manage costs and improve access to care. Aetna is seeking an Executive Director to lead the First Health business with full P&L responsibility. This role encompasses the development of annual budgets, quarterly forecasts, and long-term strategic planning. The Executive Director will oversee network management and provider relations, while also crafting a forward-looking vision to drive sustained revenue growth. This leader will manage a team of 70 professionals and be accountable for delivering $100 million in annual revenue.

Requirements

• The candidate will have a strong work ethic, be a self-starter, and be able to be highly productive in a dynamic, collaborative environment.
• This position offers broad exposure to all aspects of the company’s business, as well as significant interaction with all the business leaders.
• The candidate will be expected to have the following key attributes:
• 15+ years of experience in managed care; leading and managing teams.
• Experience contracting with providers and hospital systems.
• Strong analytical skills including root cause analysis.
• Ability to think strategically.
• Adept at execution and delivery (planning, delivering, and supporting) skills.
• Adept at collaboration and teamwork.
• Mastery of problem solving and decision-making skills.
• Mastery of growth mindset (agility and developing yourself and others) skills.
• Skilled at collaborating and working across a matrixed organization.
• 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.

Responsibilities

• Responsibility for full P&L including building of annual budgets, quarterly forecasting and strategic plans.
• Ensuring business strategies and tactics for achieving the financial commitments.
• Creating a vision and pathway to ensure long term revenue growth.
• Partnering with the Aetna network team to ensure network maintenance and development is integrated into the broader network roadmap.
• Building and maintaining an inclusive culture for the First Health team.
• Leading and ensuring network operations are maintained as required.
• Identifying new products and services they can extend the value of the First Health network.
• Leading the strategic development and expansion of the company's provider network by evaluating potential network providers, negotiating contracts, and establishing relationships with healthcare providers, hospitals, and clinics.
• Overseeing the negotiation, development, and management of contracts with network providers.
• Facilitating and tracking key performance indicators (KPIs) to assess provider performance, identify areas for improvement, and implement strategies to enhance network performance.
• Establishing positive and collaborative relationships with network providers, facilitating effective communication, and ensuring mutual understanding of expectations and contractual obligations.
• Ensuring stringent compliance with regulatory requirements and accreditation standards related to provider network management.
• Communicating with internal stakeholders, such as legal, finance, and operations, to ensure contracts are structured to meet quality, financial, and operational goals while complying with regulatory requirements.
• Implementing network strategies aligned with the organization's goals and market dynamics by evaluating market trends, competitive landscape, and patient needs to shape the network development strategy and optimize provider network composition.
• Managing operational aspects of the team, including budget, performance, and compliance, and implements workforce and succession plans to meet business needs.
• Overseeing performance expectations, provides guidance and feedback, and promotes a culture of continuous improvement and employee engagement.

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an 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.
• For more information, visit https://jobs.cvshealth.com/us/en/benefits

What This Job Offers

• Job Type: Full-time
• Career Level: Executive
• Number of Employees: 5,001-10,000 employees