Executive Director, Network Management

Job not on LinkedIn

10 hours ago

🔔 Pennsylvania – Remote

Although this job is listed in Pennsylvania, this company may be open to hiring remote in other states.

⚔️ Virginia – Remote

Although this job is listed in Virginia, this company may be open to hiring remote in other states.

+1 more states

🔔 Pennsylvania – Remote ⚔️ Virginia – Remote ⛰️ West Virginia – Remote

💵 $131.5k - $303.2k / year

⏰ Full Time

🔴 Lead

👔 Director

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CVS Health

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Healthcare Insurance • Retail • Wellness

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

📋 Description

• Overseeing key network management contracting activities, including negotiating fee schedules, reimbursement rates, and contract terms and conditions • Controlling the development and expansion of the company's provider network by evaluating potential network providers, negotiating contracts, and establishing relationships with healthcare providers to ensure a comprehensive and high-quality network • Contributing to optimizing the network's performance and effectiveness by analyzing network data, utilization patterns, and market trends to identify opportunities for network enhancements, cost savings, and improved access to care • Managing the performance of network providers, including tracking key performance indicators, analyzing provider performance data, and implementing performance improvement initiatives • Conducting market analysis, assessing competitive landscapes, and making recommendations for network expansion strategies • Communicating findings to executive leadership and stakeholders, identifying opportunities for improvement and cost containment • Managing operational aspects of the team, subsequently implementing workforce and succession plans to meet business goals and objectives • Guiding management for individual performance evaluations aimed to provide critical feedback for skills development and depth of work area experience

🎯 Requirements

• 10+ years of experience in managed care; leading and managing teams • Experience contracting with providers and hospital systems within the territory • Comprehensive understanding of hospital and physician financial issues and how to leverage technology to achieve quality and cost improvements for both payers and providers • In-depth knowledge of various reimbursement structures and payment methodologies for both hospitals and physicians • Comprehensive understanding of value-based strategies and population health management, and Aetna’s related strategic initiatives • Strong experience building and maintaining relationships with large hospitals/provider systems, integrated delivery systems and large physician groups • Understands the regulatory environment and ensures contractual compliance with federal and state requirements • Expertise in market level management, cost drivers and levers, and knowledge of economic, regulatory and marketplace issues • Possess exceptional leadership skills and transformational experience with a proven track record of delivering results • High ability to drive new strategies or initiatives in highly cross-functional environments • Effectively lead and motivate teams to ensure high standards of performance and outcomes • Strong analytical and critical thinking skills • Focus on driving disciplined, fact-based decisions, and executing with discipline and urgency • Success in moving from current traditional strategies to new, modified approaches championing change • Person must reside within the market (PA or WV) or neighboring states with a willingness to travel within the market states

🏖️ Benefits

• Affordable medical plan options • 401(k) plan (including matching company contributions) • Employee stock purchase plan • No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching • Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility