CVS Health · 8 hours ago

Lead Director, Provider Network Management

New York, NY

Full-time

Remote

Lead/Staff, Director/Executive

$100K/yr - $232K/yr

10+ years exp

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Responsibilities

Oversees key Network Management contracting activities, including negotiating fee schedules, reimbursement rates, and contract terms and conditions.

Controls 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.

Contributes 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.

Manages the performance of network providers, including tracking key performance indicators, analyzing provider performance data, and implementing performance improvement initiatives.

Conducts market analysis, assesses competitive landscapes, and makes recommendations for network expansion strategies.

Develops training sessions and communicates updates related to network management, utilization management, claims processing, and other relevant topics.

Communicates findings to executive leadership and stakeholders, identifying opportunities for improvement and cost containment.

Qualification

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Provider financial issuesHealth plan knowledgeContracting optionsFinancial strategiesMarket analysisValue-based relationshipsProvider relationshipsTraining developmentExecutive communication

Required

10+ years of experience and expert level negotiation skills with successful track record negotiating contracts with large or complex provider systems.

Command of financials and pricing strategies.

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

Health plan/payer or large provider systems knowledge and experience.

Proven analytical and financial skills.

Adept at execution and delivery (planning, delivering, and supporting).

Mastery of problem solving and decision-making skills.