Lead Director, Network Management (Northern California)

CVS Health

2d•Remote

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 is accountable for developing strategic partnerships to ensure Aetna has market leading discount and cost positions and high value, competitive networks. Strong focus on designing conceptual models, initiative planning, and negotiating high value contracts with the most complex and challenging Providers in accordance with Company standards to maintain and enhance provider networks, while working cross functionally to ensure consistency with all contracting strategies and meeting and exceeding accessibility, quality, compliance, and financial goals and cost initiatives. Contract responsibilities include Medicare and Commercial.

Requirements

10+ years related experience, including expert level negotiation skills with successful track record negotiating contracts with large or complex provider systems.
Command of financials and pricing strategies.
Ability to collaborate with a team of Contract Negotiators and Sr. Network Managers to ensure cost effective and quality provider agreements.
Proven working knowledge of provider financial issues and competitor strategies, complex contracting options, financial/contracting arrangements, and regulatory requirements.
Health plan/payer or large provider systems knowledge and experience
Proven analytical and financial skills.
Must be proficient with Microsoft Office Software (Excel, Power Point and Word)
Strong communication, critical thinking, problem resolution and interpersonal skills.
Exceptional Customer Service Skills.

Nice To Haves

Development of complex contracting relationships including FFS/Value Based/Capitation
Reside in Northern California and have experience working with providers in this market
Experience with Aetna systems including (Strategic Contract Manager, EPDB, Quickbase, Claims Systems-HRP-ACAS
Experience with ancillary provider types (Durable Medical Equipment, Home Health Care, Home Infusion)

Responsibilities

Key focus on building strong relationships with providers and develop / execute on contract strategies that yield market leading discount bringing best in class cost positions for Aetna as well as value-based partners to improve the quality and financial performance of Aetna's networks for its members.
Responsibilities include leading a negotiation Team focused on Health Systems, Hospitals and Medical Groups as well as the management of contract performance with key focus on provider engagement and financial results in accordance with Company standards (examples – pModel, SAI Targets…).
Recruit providers as needed to ensure attainment of network expansion and adequacy targets.
Collaborate cross-functionally with internal Teams to manage provider compensation and pricing development activities, submission of contractual information, and the review and analysis of reports as part of the negotiation and reimbursement modeling activities.
Accountable for cost arrangements within defined within these defined workgroups
Responsible for collaborating with cross functional Team to execute significant cost saving initiatives.
Represents company with high visibility constituents, including customers and community groups.
Promotes collaboration with internal partners.
Evaluates, helps formulate, and implements the provider network strategic plans to achieve contracting targets and manage medical costs through effective provider contracting to meet state contract and product requirements.
Collaborates with internal partners to assess effectiveness of tactical plan in managing costs.
Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.