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CVS Health

Runs pharmacies, health plans and clinics

Executive Director, Payer Contracting - Payer Contracting, Retail Health

Business OperationsConfirmed live in the last 24 hours
Full-time$131.5k - $303.2k

About the Job

Requirements

  • At least 15 years of progressive healthcare experience, including significant experience in payer or managed care contracting.
  • Demonstrated success developing payer strategies, leading complex healthcare contract negotiations, and managing senior-level payer relationships.
  • Strong understanding of healthcare reimbursement models, contract economics, payer-provider relationships, and contract performance.
  • Strong financial and analytical acumen to evaluate the business implications of complex contractual arrangements.
  • Exceptional negotiation, executive communication, relationship management, and influencing skills.
  • Ability to lead across a complex, highly matrixed healthcare organization and drive alignment among diverse stakeholders.
  • Experience leading and developing high-performing teams.
  • A bachelor's degree is required.

Responsibilities

  • Develop and execute comprehensive payer contracting strategies aligned with Retail Health business priorities, growth objectives, and evolving care delivery models.
  • Assess evolving payer, reimbursement, and healthcare market trends and translate their implications into contracting strategies and recommendations.
  • Serve as a strategic advisor to senior leadership, providing insights and recommendations on payer strategy, contracting opportunities, risks, and performance.
  • Lead and develop a high-performing payer contracting team while establishing clear priorities, accountability, and consistent contracting practices.
  • Lead complex payer negotiations, renewals, amendments, and strategic contract discussions across national and regional health plans.
  • Build and maintain senior-level payer relationships and identify opportunities to strengthen and expand those partnerships.
  • Evaluate reimbursement terms, contract economics, financial opportunities, and risks to inform negotiation strategies and business decisions.
  • Oversee the payer contract portfolio, establishing priorities and ensuring contracts deliver against financial, operational, and strategic objectives.
  • Monitor contract performance and identify opportunities to improve reimbursement, contract value, and overall performance.
  • Partner with Finance, Legal, Revenue Cycle, Operations, Clinical, and Compliance to ensure effective contract development, implementation, and ongoing execution.
  • Lead resolution of significant payer contracting issues, disputes, and escalations.

Desired Qualifications

  • Deep experience with national and regional health plans and government and commercial payer contracting, particularly within ambulatory, physician, or retail health environments.
  • An advanced degree is preferred.

About the Company

CVS Health

Runs pharmacies, health plans and clinics

CVS Health runs pharmacies, health insurance plans and medical clinics for individuals, employers and government programs across the United States. Its businesses include CVS Pharmacy, the Aetna insurer and Caremark, which manages prescription coverage and negotiates drug prices for health plans. Patients fill prescriptions in stores or by mail and receive care through walk-in clinics, primary care centers and home visits. The company earns money from prescription sales, insurance premiums, plan administration fees and clinical services, combining coverage with places to obtain treatment. Its first store opened in 1963, and its headquarters are in Woonsocket, Rhode Island.

Company size
10,001+
Company stage
IPO
Headquarters
Woonsocket, Rhode Island
Founded
1963

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