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Position Summary
The Lead Director will manage the development of contracts and agreements with providers and delivery systems in conjunction with being accountable for designing conceptual models, initiative planning, and negotiating high value contracts with Medicaid providers/facilities in accordance with company standards in order 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.

The Lead director negotiates and executes, conducts high level review and analysis, dispute resolution and/or settlement negotiations. Manages contract performance and supports the development and implementation of value-based contract relationships in support of business strategies. Recruits providers as needed to ensure attainment of network expansion and adequacy targets. Accountable for cost arrangements within defined territories. Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review analysis of reports as part of negotiation and reimbursement modeling activities. Oversees and directly manages a team of contract negotiators. Responsible for identifying and managing cost issues and initiating appropriate cost saving initiatives and/or settlement activities. Assists with the design, development, management, and or implementation of strategic network configurations and integration activities. Recruits providers as needed to ensure attainment of network expansion and adequacy targets. Accountable for cost arrangements within defined groups. Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities. Responsible for identifying and managing cost issues and collaborating cross functionally 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. May optimize interaction with assigned providers and internal business partners to facilitate relationships and ensure provider needs are met. Ensures resolution of escalated issues related to contract interpretation and parameters. Interprets contractual requirements including federal and state regulations and NCQA. Participates in JOC meetings. Promotes and educate providers on cultural competency. Sets specific, challenging and achievable objectives and action plans. Manages complex, contractual relationships with providers according to prescribed guidelines in support of national and regional network strategies. Mentor and coach new/more junior staff to educate and inform on accreditation and regulatory standards as well as policies on credentialing and re-credentialing.

Required Qualifications
7+ years related experience and expert level negotiation skills with successful track record negotiating contracts which includes experience within Network Medicaid management.

Proven working knowledge of provider financial issues and competitor strategies, complex contracting options, financial/contracting arrangements, and regulatory requirements including network adequacy monitoring.

Demonstrated ability to identify and manage initiatives that improve total medical cost and quality. 

Health Plan/Payer or Provider Systems experience

Must reside in Illinois

Preferred Qualifications
Experience in Medicaid provider/facility contracting

Previous experience directly managing personnel

Medicaid regulatory experience

Medicaid contracting & setup experience.

Strong Communication, critical thinking, problem resolution and interpersonal skills

Ability to multi-task, prioritize and meet deadlines.

Working knowledge of value-based contracts.

Education

Bachelor’s Degree or equivalent professional experience.

Pay Range

The typical pay range for this role is:

$100,000.00 - $231,540.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.  This position also includes an award target in the company’s equity award program. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. 
 
For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 12/31/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.