Lead Director, Provider Performance Value-Based Care

CVS Health•Work At Home-North Carolina, NC

1d•$100,000 - $231,540

About The Position

The Lead Director of Value-Based Contracting establishes and maintains productive value-based relationships with key network providers and develops and manages the Keystone Value-based Network. The role builds strategic relationships with provider partners to develop innovative value-based solutions that support total cost and quality goals. It develops alternative payment models, plans new initiatives, and negotiates high-value and high-risk contracts with complex arrangements, taking providers’ volume and cost structures into account and coordinating negotiation strategies across relevant functions and organizational goals. The position manages the complete value-based contracting cycle, from planning and document creation through negotiation and loading executed arrangements. In partnership with Performance, Clinical Transformation, VBS Analytics, and other internal teams, the Lead Director develops value-based strategy and oversees contract performance with targeted provider groups. The role also evaluates, formulates, and implements network strategic plans to meet contracting targets and manage medical costs. The Lead Director supports other departments in obtaining required provider information, including HEDIS, credentialing, grievance and appeals, and SIU information, and coordinates provider status information with member services and other internal departments. The position leads complex projects and programs from assessment through implementation, potentially affecting multiple processes, systems, functions, and products across all lines of business, and attends external provider meetings and negotiations as needed.

Requirements

10 years of related experience.
Comprehensive negotiating skills and a successful track record negotiating value-based contracts with IPAs, large complex provider systems or groups, hospitals, and large physician entities.
Experience reviewing medical claims data, developing executive summaries, and identifying opportunities to mitigate medical cost trends.
Excellent analytical and problem-solving skills.
Strong communication, negotiation, and presentation skills.
Ability to work in a matrixed organization, gain consensus, and share information with various interested parties.

Nice To Haves

Familiarity with legal terms in the context of provider contracting.
Familiarity with CMS Stars and HEDIS technical specifications and measurable percentiles associated with HEDIS measures.
Experience with Commercial, Medicare, and Medicaid contracting.
Ability to apply systems thinking when managing multiple provider value-based initiatives.
Strong financial modeling background.
Bachelor’s degree preferred, or a combination of professional work experience and education.

Responsibilities

Establish and maintain productive value-based relationships with key network providers and develop and manage the Keystone Value-based Network.
Build strategic provider relationships and develop innovative value-based solutions to meet total cost and quality goals.
Develop alternative payment models and identify and plan new initiatives.
Negotiate high-value and high-risk contracts with complex arrangement structures, considering provider volume and cost structures and coordinating negotiation strategies with relevant functions and organizational goals.
Manage the complete value-based contracting cycle, including planning, document creation, negotiation, and loading executed arrangements.
Work with Performance, Clinical Transformation, VBS Analytics, and other internal teams to develop value-based strategy and oversee contract performance with targeted provider groups.
Evaluate, formulate, and implement network strategic plans to achieve value-based contracting targets and manage medical costs.
Assist other departments in obtaining required provider information, including HEDIS, credentialing, grievance and appeals, and SIU information.
Coordinate provider status information with member services and other internal departments.
Lead complex projects and programs from assessment through implementation that may affect multiple processes, systems, functions, and products across all lines of business.
Facilitate and attend external provider meetings and negotiations as needed.