Lead Director Network Activation

CVS Health•Work At Home-Texas, TX

2d•$100,000 - $231,540•Hybrid

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, Network Activation is an executive leadership role responsible for advancing the organization's vision of a best-in-class operational ecosystem supporting provider enrollment, credentialing, and network activation initiatives across government and commercial payer programs. This position serves as the strategic leader for payer enrollment operations, ensuring seamless integration of federal, state, and commercial program requirements while supporting organizational growth and revenue integrity. As a leader of leaders, the Lead Director oversees a team of Manager-level leaders and is accountable for fostering a high-performance culture focused on employee engagement, professional development, operational excellence, and continuous improvement. The role plays a critical part in protecting revenue by accelerating provider enrollment timelines, reducing enrollment-related claim denials, optimizing group enrollment strategies, and developing scalable processes that support national expansion.

Requirements

Minimum of 10 years of progressive leadership experience in provider enrollment, payer enrollment, credentialing, healthcare operations, or revenue cycle management.
Minimum of 3 years of experience leading leaders, including direct management of Manager-level teams.
Demonstrated experience managing Medicare, Medicaid, and commercial payer enrollment operations.
Proven success leading large-scale operational initiatives, process improvements, and organizational growth strategies.
Demonstrated ability to develop leaders, build high-performing teams, and foster a culture of accountability and engagement.
Strong coaching, mentoring, performance management, and succession planning capabilities.
Excellent organizational leadership, change management, and stakeholder management skills.
Comprehensive knowledge of provider enrollment and credentialing processes within government and commercial payer environments.
Deep understanding of CMS regulations, PECOS, NPPES, CAQH, Medicaid Management Information Systems (MMIS), and commercial payer enrollment requirements.
Strong knowledge of healthcare reimbursement processes, including 835 and 837 transactions, denial management, and revenue cycle operations.
Familiarity with NCQA standards and healthcare regulatory requirements.
Ability to analyze complex operational and financial challenges and implement sustainable solutions.
Experience navigating diverse state regulations and payer-specific requirements across multiple markets.
Strong business acumen with the ability to align operational performance with organizational objectives.
7 to 10 years of experience in stakeholder management
Exceptional written, verbal, and interpersonal communication skills.
Proven ability to influence and collaborate effectively with executive leadership, clients, payers, regulatory agencies, and cross-functional stakeholders.
Strong negotiation, presentation, and conflict-resolution skills.
Primarily operates in a professional office or remote work environment.
Occasional travel may be required up to 25% to support client meetings, operational initiatives, and strategic business objectives.
Must be able to manage multiple priorities and perform effectively in a dynamic, fast-paced healthcare environment.
Bachelor’s degree in healthcare administration, Business Administration, Public Health, or a related field required.

Nice To Haves

Master’s degree in healthcare administration (MHA), Business Administration (MBA), or related discipline preferred

Responsibilities

Provide strategic leadership and direction to a team of Manager-level leaders responsible for provider enrollment and network activation functions.
Develop and maintain a high-performing leadership team through coaching, mentoring, succession planning, and professional development initiatives.
Foster a culture of accountability, collaboration, engagement, and continuous learning across the department.
Establish clear performance expectations, monitor results, and drive achievement of departmental and organizational goals.
Lead efforts to build and scale a best-in-class Network Activation function that supports organizational growth and operational excellence.
Direct enterprise-wide enrollment strategies for Medicare, Medicaid, and commercial payer programs to ensure timely provider participation and regulatory compliance.
Oversee enrollment operations across multiple markets, ensuring adherence to federal, state, and payer-specific requirements.
Monitor changes in regulatory and enrollment requirements and implement proactive strategies to address evolving policies, revalidation requirements, and market-specific mandates.
Collaborate with internal and external stakeholders to support successful payer onboarding, delegation activities, and network expansion initiatives.
Participate in and, when appropriate, lead client pre-delegation discussions and review Statements of Work (SOWs) to ensure operational readiness and alignment.
Advocate for strategic state licensing and enrollment initiatives that support organizational growth objectives.
Partner with Compliance and Quality teams to maintain alignment with NCQA standards and accreditation requirements.
Serve as the executive leader responsible for mitigating enrollment-related revenue risks and ensuring provider reimbursement readiness.
Partner closely with Revenue Cycle Management, Billing, Finance, and Operations teams to identify and eliminate enrollment-related barriers impacting claims processing and reimbursement.
Analyze trends related to enrollment delays, claim denials, and revenue leakage, implementing corrective actions and process improvements.
Lead root cause analysis efforts to resolve payer enrollment issues affecting reimbursement timelines and provider revenue.
Develop and implement operational strategies that minimize provider write-offs and improve organizational financial performance.
Serve as the senior point of escalation for complex client concerns related to enrollment, credentialing, network participation, and reimbursement issues.
Manage strategic client communications regarding enrollment status, claims impacts, operational performance, and remediation plans.
Build and maintain trusted relationships with executive stakeholders, health plans, government agencies, healthcare organizations, and internal leadership teams.
Lead business reviews and executive-level discussions regarding enrollment performance, operational metrics, and continuous improvement initiatives.
Establish key performance indicators (KPIs), service-level agreements (SLAs), and operational benchmarks to measure departmental effectiveness.
Drive process optimization, automation initiatives, and operational efficiencies that improve scalability and service delivery.
Collaborate with cross-functional teams, including Credentialing, Compliance, Revenue Cycle, Legal, Provider Operations, and Client Services, to support enterprise initiatives.
Provide strategic recommendations to executive leadership regarding enrollment operations, payer contracting readiness, and organizational growth opportunities.