Lead Director, National Health Systems Contracting
About The Position
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary The Lead Director of National Health Systems (NHS) Contracting is responsible for overseeing Network contracting activities and maintaining productive relationships with key national health system providers. Responsible to develop and manage the NHS Network as outlined below: Oversees key Network contracting activities, including negotiating rates, Value--Based Care development and contract terms. Collaborates with the Executive Director for negotiations with the national health systems. Supports Senior Manager, Network Management to load complex hospital contracts accurately and timely. Assesses provider performance metrics, such as utilization rates, patient satisfaction scores, and claims data to identify areas for improvement and cost containment. Collaborates with providers to implement initiatives that optimize quality and efficiency of services. Provides assistance and support to other departments, as needed, to obtain crucial or required information from providers, such as HEDIS, Credentialing, etc. Leads work and deliverables of complex projects/programs, through assessment to implementation, that may impact multiple processes, systems, functions, and products across all lines of business. Excellent analytical and problem-solving skills Strong communication, negotiation, and presentation skills Ability to work in a matrixed organization and gain consensus and share information to various interested parties.
Requirements
- A minimum of 7 years of related experience and comprehensive level of negotiating skills with successful track record negotiating contracts with large complex provider systems or groups, hospitals and large physician and risk bearing entities
- A minimum of 5 years of related experience reviewing medical claims data and developing executive summaries and identifying opportunities for mitigating medical cost trend
- Familiar with legal terms in the context of provider contracting and contracting management systems.
- Excellent analytical and problem-solving skills
- Strong communication, negotiation, and presentation skills
- Ability to work in a matrixed organization and gain consensus and share information to various interested parties.
Nice To Haves
- Familiar with CMS Stars and HEDIS technical specifications and various measurable percentiles associated with the HEDIS measures.
- Experience with Commercial, Medicare, and Individual Medicaid contracting.
- Strong financial modeling background.
Responsibilities
- Oversees key Network contracting activities, including negotiating rates, Value--Based Care development and contract terms.
- Collaborates with the Executive Director for negotiations with the national health systems.
- Supports Senior Manager, Network Management to load complex hospital contracts accurately and timely.
- Assesses provider performance metrics, such as utilization rates, patient satisfaction scores, and claims data to identify areas for improvement and cost containment.
- Collaborates with providers to implement initiatives that optimize quality and efficiency of services.
- Provides assistance and support to other departments, as needed, to obtain crucial or required information from providers, such as HEDIS, Credentialing, etc.
- Leads work and deliverables of complex projects/programs, through assessment to implementation, that may impact multiple processes, systems, functions, and products across all lines of business.
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.
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What This Job Offers
Job Type
Full-time
Career Level
Director
Number of Employees
5,001-10,000 employees
