Lead Director, Network Management (Oklahoma)

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. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

• The Lead Director will manage the development of contracts and agreements with providers and delivery systems in conjunction with being accountable for designing conceptual models, initiative planning, and negotiating high value/risk contracts with the most complex and challenging, market/region/national, largest group/system or highest value/volume of spend providers in accordance with company standards in order to maintain and enhance provider networks, while working cross functionally to ensure consistency with all contracting strategies and meeting and exceeding accessibility, quality, compliance, and financial goals and cost initiatives.
• Negotiates and executes, conducts high level review and analysis, dispute resolution and/or settlement negotiations of contracts with larger and more complex, market-based, group/system providers.
• Manages contract performance and supports the development and implementation of value-based contract relationships in support of business strategies.
• Recruits providers as needed to ensure attainment of network expansion and adequacy targets.
• Accountable for cost arrangements within defined groups. Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review analysis of reports as part of negotiation and reimbursement modeling activities.
• Responsible for identifying and managing cost issues and initiating appropriate cost saving initiatives and/or settlement activities. Assists with the design, development, management, and or implementation of strategic network configurations and integration activities.
• Drives or guides development of holistic solutions or strategic plans negotiates and executes contracts with the most complex, market /region/national, largest group/system or highest value/volume of spend providers with significant financial implications.
• Recruits providers as needed to ensure attainment of network expansion and adequacy targets.
• Accountable for cost arrangements within defined groups.
• Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities. Responsible for identifying and managing cost issues and collaborating cross functionally to execute significant cost saving initiatives.
• Represents company with high visibility constituents, including customers and community groups.
• Promotes collaboration with internal partners.
• Evaluates, helps formulate, and implements the provider network strategic plans to achieve contracting targets and manage medical costs through effective provider contracting to meet state contract and product requirements.
• Collaborates with internal partners to assess effectiveness of tactical plan in managing costs.
• May optimize interaction with assigned providers and internal business partners to facilitate relationships and ensure provider needs are met.
• Ensures resolution of escalated issues related to contract interpretation and parameters.
• Interprets contractual requirements including federal and state regulations and NCQA.
• Participates in JOC meetings.
• Promotes and educate providers on cultural competency.
• Sets specific, challenging and achievable objectives and action plans.
• Manages complex, contractual relationships with providers according to prescribed guidelines in support of national and regional network strategies.
• Mentor and coach new/more junior staff to educate and inform on accreditation and regulatory standards as well as policies on credentialing and re-credentialing.

• 10+ years of related healthcare contracting experience, including expert-level negotiation skills and a proven track record of successfully negotiating contracts with large, complex national providers and vendor organizations.
• 2+ years of people leadership experience, with demonstrated ability to lead, develop, and influence high-performing teams.
• Strong knowledge of provider financial management, competitive market strategies, complex contracting methodologies, value-based and risk-based arrangements, and applicable regulatory requirements.
• Demonstrated success identifying and leading initiatives that improve total cost of care, enhance quality outcomes, and drive organizational performance.
• Extensive experience within a health plan, payer, or provider system environment, with a deep understanding of healthcare delivery and reimbursement…