Executive Director, Medicaid Provider Relations – Contracting

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🔥 0 minutes ago

🏖️ New Jersey, New York, +4 more states – Remote

🏖️ New Jersey – Remote 🗽 New York – Remote 🦀 Maryland – Remote 🔔 Pennsylvania – Remote ⚔️ Virginia – Remote ⛰️ West Virginia – Remote

💵 $131.5k - $303.2k / year

⏰ Full Time

🔴 Lead

👔 Director

👻 Ghost score 0%

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

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.

📋 Description

• Lead provider relations and contracting activities across multiple Medicaid markets within the Northeast Region • Create consistent provider engagement standards and contracting practices while adapting to state-specific requirements • Develop scalable provider strategies that improve execution, operational efficiency, and provider experience • Drive best-practice sharing across markets to strengthen provider partnerships and improve network performance • Support complex provider negotiations and contracting initiatives spanning multiple markets or provider systems • Develop regional dashboards and executive reporting on provider satisfaction, network health, and contracting outcomes • Lead development and execution of Medicaid provider engagement and contracting strategies • Align activities with market priorities, growth objectives, regulatory requirements, and business performance goals • Serve as a senior Network leader and partner to market, regional, compliance, operations, clinical, and government programs leadership • Build and maintain relationships with provider organizations, health systems, physician groups, ancillary providers, behavioral health partners, and community-based organizations • Oversee provider outreach, education, issue resolution, escalation management, and ongoing engagement • Use provider feedback and market insights to improve provider experience and reduce avoidable friction • Provide executive oversight of Medicaid provider contracting strategy, negotiation support, and network development priorities • Ensure network adequacy standards are met and sustained • Ensure alignment with state Medicaid contracts, regulatory requirements, audit standards, and internal policies • Partner with Compliance, Legal, and Government Programs teams on regulatory issues, corrective actions, and risk mitigation • Maintain readiness for state reviews, audits, reporting requests, and network adequacy validations • Evaluate network health, provider satisfaction, access, issue trends, and operational effectiveness using data and reporting • Develop executive-level reporting, recommendations, and business updates for senior leadership • Resolve complex provider issues related to access, claims, operations, reimbursement, and service experience • Lead and develop provider-facing and contracting colleagues through performance expectations, coaching, and talent development • Foster a collaborative, inclusive, market-focused culture centered on execution and continuous improvement • Support workforce planning, succession planning, and change leadership as work transitions into local market structures

🎯 Requirements

• Must live in Virginia, West Virginia, Maryland, Pennsylvania, New Jersey or New York • 10+ years of progressive experience in Medicaid network management, provider relations, provider contracting, managed care, or a related healthcare leadership role • 5+ years of leadership experience managing provider-facing, contracting, or network management teams • Demonstrated experience working in Medicaid programs and navigating complex state regulatory environments • Proven ability to influence senior leaders, manage complex provider relationships, and lead execution in a matrixed organization • Strong analytical, communication, negotiation, and relationship-building skills • Bachelors degree or equivalent • Preferred: Experience leading provider relations and contracting functions across multiple Medicaid states • Preferred: Strong understanding of multi-state Medicaid operations, regulatory requirements, and market variation • Preferred: Experience managing geographically dispersed teams through change or operating model transformation • Preferred: Demonstrated ability to create common standards while preserving appropriate local market flexibility

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program • Award target in the company’s equity award program • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being