CVS Health · 5 hours ago

Lead Director, Network Management - North Carolina Medicaid Contracting

North Carolina, United States

Full-time

Remote

Senior Level, Lead/Staff, Director/Executive

$100K/yr - $232K/yr

7+ years exp

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Responsibilities

Design conceptual models for Medicaid provider networks.

Plan initiatives related to Medicaid contracting.

Negotiate Medicaid value-based agreements with North Carolina providers.

Work cross functionally to ensure consistency with all contracting strategies.

Meet and exceed accessibility, quality, compliance, regulatory, and financial goals and cost initiatives.

Qualification

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Provider financial issuesMedicaid contractingHealth Plan/Payer experienceRegulatory requirementsInitiative managementMedicaid regulatory experienceNorth Carolina providers

Required

Minimum 7+ years related experience and expert level negotiation skills with successful track record negotiating contracts with large or complex national vendors/providers.

Proven working knowledge of provider financial issues and competitor strategies, complex contracting options, financial/contracting arrangements, and regulatory requirements.

Demonstrated ability to identify and manage initiatives that improve total medical cost and quality.

Health Plan/Payer or Provider Systems experience

Bachelor's degree or equivalent professional work experience.