Lead Director, Provider Performance Value-Based Care

Job not on LinkedIn

🕒 July 29

🇺🇸 United States – Remote

💵 $100k - $231.5k / year

⏰ Full Time

🟠 Senior

👔 Director

👻 Ghost score 23%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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

• Establish and maintain productive value-based relationships with key network providers • Develop and manage the Keystone Value-based Network • Build strategic provider-partner relationships and develop innovative value-based solutions to meet total cost and quality goals • Develop alternative payment models and identify and plan new initiatives • Negotiate high-value/risk contracts with complex arrangement structures • Understand providers’ volume and cost structures • Work cross-functionally to identify negotiation levers and critical points • Align negotiation strategies with network accessibility, quality, compliance, and financial performance goals • Manage the complete value-based contracting cycle from planning and document creation through negotiation and loading executed arrangements • Develop value-based strategic plans and oversee contract performance with targeted provider groups • Evaluate, formulate, and implement network strategic plans to achieve contracting targets and manage medical costs • Support other departments in obtaining required provider information, including HEDIS, Credentialing, Grievance and Appeals, and SIU information • Coordinate provider status information with member services and internal departments • Lead complex projects and programs from assessment through implementation across processes, systems, functions, and products • Facilitate and attend external provider meetings and negotiations as needed

🎯 Requirements

• 10 years of related experience • Comprehensive negotiating skills with a successful track record negotiating value-based contracts with IPAs, large complex provider systems or groups, hospitals and large physician entities • Experience reviewing medical claims data • Experience developing executive summaries and identifying opportunities to mitigate medical cost trend • Excellent analytical and problem-solving skills • Strong communication, negotiation, and presentation skills • Ability to work in a matrixed organization, gain consensus, and share information with various interested parties • Familiarity with legal terms in the context of provider contracting • Familiarity with CMS Stars and HEDIS technical specifications and measurable percentiles associated with HEDIS measures • Experience with Commercial, Medicare and Medicaid contracting • Ability to apply systems thinking when managing multiple provider value-based initiatives • Strong financial modeling background • Must reside in the state of Georgia • Bachelor’s degree preferred or a combination of professional work experience and education

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program • 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