Lead Director, Network Compliance & Regulator - Northeast

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do.

Role will be hybrid if a person sits within 25 miles of an office

This dynamic role on the Network Strategy and Provider Experience team supports state and regulatory network‑related inquiries, filings, data requests, and more. The incumbent partners with Compliance and Regulatory Affairs to understand specific compliance requirements for their assigned region, national mandates such as Mental Health Parity (MHP), and network implications. They lead the production of network exhibits for state‑specific filings, coordinate with Provider Data Services and the Network Government Services team, and manage submissions for MCCs and local network teams.

The position serves as the primary point of accountability for network regulatory readiness and risk management within the region.

• Produce and oversee the completion of network exhibits required for state‑specific network filings to meet regulatory specifications.
• Coordinate and lead network responses and preparation for regulator‑identified adequacy gaps, including analysis, justification narratives, alternative access filings (AADRs), and documented recruitment efforts.
• Manage market conduct exams, CMS audits, DOI exams, accreditation reviews (e.g., NCQA), and ad‑hoc regulatory inquiries.
• Ensure accurate, timely data submission, narrative responses, and supporting documentation across all required regulatory forums.
• Support and track corrective action plans, appointment wait time remediation, and mitigation strategies as needed.
• Participate in and provide network leadership representation for the network adequacy oversight committee.
• Partner with compliance, legal, and regulatory teams to ensure consistency and accuracy of guidance shared with network leadership teams.
• Serve as the primary network liaison and subject matter advisor for compliance and regulatory initiatives.
• Serve as Network’s business area contact (BAC) and primary liaison for the Business Compliance Office (BCO) in support of mandate implementation.
• Foster a culture of regulatory compliance, accountability, transparency, and collaboration across network and partner teams.

Required Qualifications & Experience

• 10+ years of experience within the healthcare industry.
• 3–5 years of experience supporting healthcare regulatory and compliance frameworks impacting provider networks.
• Strong program leadership, organizational, and meeting facilitation skills.
• Demonstrated ability to deliver executive‑level communication, reporting, and stakeholder management.
• Experience partnering cross‑functionally with Legal, Compliance, Regulatory, Operations, and provider‑facing teams.
• Proven ability to translate complex requirements into clear, actionable guidance and scalable operational processes.
• Proficient in Microsoft Office Suite (Excel, PowerPoint, Word, Teams).
• Willingness and ability to travel as needed.

Preferred Qualifications

• Working knowledge of provider network structures, data, and supporting systems.
• Ability to interpret and apply regulatory requirements within a healthcare/network environment.
• Strong cross‑functional collaboration skills across diverse stakeholder groups.
• Proven ability to deliver executive‑level communication and influence decision‑making.
• Demonstrated strength in risk identification, mitigation, and problem‑solving.
• Experience driving change‑management initiatives and operational execution.
• Familiarity with data and analytics platforms such as Alteryx, Dataiku, or similar tools.

Pay Range:
The typical pay range for this role is $ – $. This represents the base hourly rate or base annual full‑time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This role is eligible for a CVS Health bonus, commission or short‑term incentive program in addition to the base pay range listed above.

It also includes an award target in the company’s equity award program.

Benefits:
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. Benefits include medical, dental, vision coverage, paid time off, retirement savings options, wellness programs, and other resources based on eligibility.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.