Lead Director, Value-Based Contracting (Central Region)

CVS Health•Carapichaima, MO

3d•$100,000 - $231,540

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 Value-Based Contracting is responsible for establishing and maintaining productive value-based relationships with key network providers. Responsible to develop and manage the Value-based Network for a Region as outlined below: Accountable for building strategic relationships with our provider partners to develop innovative value-based solutions to meet total cost and quality goals. Responsible for developing alternative payment models, identifying and planning new initiatives, and negotiating high value/risk contracts with the most complex arrangement structures, which requires: understanding providers’ volume and cost structure working cross functionally to identify the levers and critical negotiation points aligning negotiation strategies and tactics with network accessibility, quality, compliance, and financial performance goals In charge of complete value-based contracting cycle from planning, creating documents, negotiation and loading of executed arrangements. Works with Performance team, Clinical Transformation team, VBS Analytics team and other key internal teams to develop a value-based strategic plan and oversee contract performance with targeted provider groups to ensure we meet objectives for value-based provider agreements. Evaluates, helps formulate, and implements network strategic plans to achieve value-based contracting targets and manage medical costs through effective value-based contracting. Provide 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. Facilitates and attends external provider meetings and negotiations, as needed. Manage Value-Based ACO products (Aetna Whole Health local networks); this may include day-to-day management in addition to the contracting of ACO product deal terms. Assumes supervisory responsibilities for VBC contracting team members. Assists Executive Director, Provider Performance, in developing and driving strategies to achieve organizational goals. Serves as support and back-up to Executive Director, Provider Performance, as needed. Drives and monitors consistency and adherence to policies/protocols of department. Assists in identification and promotion of best practices within Team. Identifies training and/or educational needs within Team. Oversees training plan for new Team contracting colleagues.

Requirements

10+ years of related experience
Comprehensive level of negotiating skills with successful track record negotiating value-based contracts with IPAs, large complex provider systems or groups, hospitals and large physician and risk bearing entities
Experience developing executive summaries and identifying opportunities for mitigating medical cost trend
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 legal terms in the context of provider contracting
Familiar with CMS Stars and HEDIS technical specifications and various measurable percentiles associated with the HEDIS measures
Experience with Commercial, Medicare, and Individual Exchange contracting
Able to apply system thinking when managing multiple provider value-based initiatives
Strong financial modeling background

Responsibilities

Establishing and maintaining productive value-based relationships with key network providers.
Developing and managing the Value-based Network for a Region.
Building strategic relationships with provider partners to develop innovative value-based solutions to meet total cost and quality goals.
Developing alternative payment models, identifying and planning new initiatives, and negotiating high value/risk contracts with complex arrangement structures.
Managing the complete value-based contracting cycle from planning, creating documents, negotiation, and loading of executed arrangements.
Working with Performance team, Clinical Transformation team, VBS Analytics team, and other key internal teams to develop a value-based strategic plan and oversee contract performance.
Evaluating, formulating, and implementing network strategic plans to achieve value-based contracting targets and manage medical costs.
Providing assistance and support to other departments to obtain crucial information from providers.
Leading work and deliverables of complex projects/programs that may impact multiple processes, systems, functions, and products.
Facilitating and attending external provider meetings and negotiations.
Managing Value-Based ACO products (Aetna Whole Health local networks).
Assuming supervisory responsibilities for VBC contracting team members.
Assisting Executive Director, Provider Performance, in developing and driving strategies.
Serving as support and back-up to Executive Director, Provider Performance.
Driving and monitoring consistency and adherence to policies/protocols of the department.
Assisting in the identification and promotion of best practices within the Team.
Identifying training and/or educational needs within the Team.
Overseeing the training plan for new Team contracting colleagues.