Lead Director, Network and Trend Optimization - West Region Remote

CVS Health

96d • $100,000 - $231,540

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 Overview Reports To: Executive Director, Region Development Officer Manages medical cost by partnering with Provider Contracting, MEU, Pharmacy, Claims Cost Management, Innovation, and Clinical to ensure aggressive management of medical cost trends to achieve the best price for our products and services. Connects internal and external relationships within the Commercial segment, across all Aetna shared services, to drive commercial medical development activities and frameworks to integrate business strategies across the Enterprise.

Requirements

• Minimum of 7-10 years in healthcare industry experience, network management, contracting, actuarial, underwriting, finance, clinical operations, trend analytics, and/or related field.
• At least 5 years in a role involving cross-functional collaboration.
• Strong understanding of healthcare systems, reimbursement models, healthcare cost trends, network contracting principles, and provider relations.
• Proven ability to analyze and interpret complex data sets to develop actionable strategies.

Nice To Haves

• Experience working with sales teams and commercial stakeholders.
• Experience with healthcare data analytics platforms and electronic health record (EHR) systems.
• Knowledge of regional healthcare regulations and reimbursement models.
• Certification in healthcare finance or management (e.g., HFMA, ACHE).

Responsibilities

• Act as the primary point of contact for the West Region between network, medical economics, clinical operations, finance team, and sales teams to align financial strategies with clinical objectives and market needs.
• Develop and execute strategic initiatives through pricing, network curation, and medical management that lead to sustainable long-term growth and revenue.
• Develop and implement strategies to align with network contracting priorities with commercial trend management goals.
• Ensure the organization maintains competitive network arrangements to support cost-effective and high-quality care delivery.
• Collaborate with network teams, and sales to improve cost positions in core markets.
• Leverage high-value networks and innovative payment models to enhance care affordability and access.
• Identify and execute meaningful initiatives to mitigate trends and provide competitive products.
• Track and analyze industry trends and healthcare utilization benchmarks.
• Provide actionable insights to contracting teams to ensure strategic decision-making.
• Collaborate with Local Market Trend Committees and National Commercial Trend Committees.
• Partner with sales teams in top-tier priority markets to develop strategies that improve our network’s cost position and support commercial objectives.
• Participate in high-level meetings with network leadership and commercial stakeholders to present findings, propose initiatives, and drive decision-making processes.
• Establish and oversee key performance indicators (KPIs) to track the success of implemented strategies and ensure continuous improvement.
• Develop and deliver regular updates to leadership on network performance and trend analysis.
• Create dashboards and reports that track progress toward achieving key performance indicators.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: Bachelor's degree