Lead Director – Medical Pharmacy Network

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🔥 1 minute ago

🥔 Idaho, Kentucky, +1 more states – Remote

🥔 Idaho – Remote 🐎 Kentucky – Remote 🤠 Texas – Remote

💵 $100k - $231.5k / year

⏰ Full Time

🟠 Senior

👨‍⚕️ Medical Director

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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

• Drive network strategy and performance improvement for medical drug reimbursement across hospital, health system, and regional provider partners • Enable market teams with contracting guidance, analytics, and best practices to improve cost, quality, and access outcomes • Develop market network contract relationships and support market agreements and negotiations with health systems, hospitals, and regional provider groups • Align medical pharmacy strategy with National Ancillary Network and Value-Based Care teams • Design strategic retail network initiatives and plans by analyzing market trends, competitive advantages, and opportunities to improve network effectiveness and efficiency • Define programs integrating provider network strategy with business objectives in collaboration with operations, marketing, and finance • Control systems monitoring medical pharmacy and infusion provider network performance; analyze KPIs and identify improvement areas • Communicate with external healthcare organizations and insurance providers to establish partnerships and collaborative arrangements • Align retail provider network strategies with legal and regulatory frameworks and ensure compliance with health regulations and standards • Advise senior management and stakeholders on provider network performance, patient expectations and outcomes, and financial metrics and targets • Design strategies for retail network performance and partner with market leaders to meet business plan requirements and team objectives

🎯 Requirements

• At least 10 years of experience in health plan operations, network contracting, or provider-facing contracting environments • At least 3 years of experience in a health plan setting, with exposure to payer operations and healthcare administration • Ability to translate complex contracting, financial, and operational information into concise executive-level narratives • Ability to critically evaluate contract terms, reimbursement structures, and business proposals • Ability to challenge unfavorable provisions, mitigate risk, protect organizational interests, and support strategic objectives • Knowledge of medical pharmacy reimbursement and outpatient reimbursement models, including payer and provider considerations • Experience with health system and hospital network contracts preferred • Contracting experience with infusion, medical pharmacy arrangements, and/or value-based care preferred • Bachelor's degree preferred, or a combination of education and work experience

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program in addition to the base pay range • 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, based on eligibility