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Lead Director, Duals Provider Network Strategy

Woonsocket, RI, USA | CVS Health

  • Industry:
    Healthcare - Hospitals
  • Position Type:
  • Functions:
    General Management
  • Experience:
    10-12 years
Job Description:
67 people have viewed this job

Accountable for the strategic direction and execution of the provider network for our Medicare Duals products with a heavy emphasis on Value Based Contracting arrangements.

• Develop customized provider network solution for Medicare Duals plans

• Lead Value Based Contracting strategy for Medicare Duals segment.

• Take active role in driving VBS pipeline to fuel growth and results.

• Provide oversight for network adequacy monitoring and help solution when network gaps arise.

• Maintain a strategic focus and relationship while driving collaboration with contracting teams.

• Define and drive Duals LTSS strategy.

• Plan and prepare for expansion of product portfolio.

• Ensure optimal integration of Medicare and Medicaid networks.

• Analyze unit cost performance and implement solutions based on findings.

• Support ISNP

• Drive network issue resolution across matrix organization.

• Able to advise/counsel network partners on value-based negotiations, deal terms and best practices.

• Drive provider performance and partners with local market to ensure pathways to performance against business and team objectives.

Remote based from any U.S. location

Pay Range

The typical pay range for this role is:

Minimum: 100,000

Maximum: 227,000

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications

• 5+ years’ experience working with VBCs (value based contracts)

• 10+ years’ experience managing matrixed environment with ability to leverage internal business partners to complete tasks

• Proven track record managing complex projects and or programs that resulted in cost savings

• Strong interpersonal and executive presentation skills

• 5+ years working with providers and maintaining strong provider relationships

• 10+ years of managed care experience.

• 5+ years’ experience with provider contracting, plan design, and product offerings

• Self-directed individual who requires minimal supervision

• Proven ability to interact with, influence and collaborate with internal and external stakeholders at all levels as demonstrated by 10 years of applicable experience.

• Demonstrated ability to problem solve independently

Preferred Qualifications

• Subject matter expertise working with dual eligible and other Special Needs Plans (e.g., FIDE, HIDE, MMP, DSNP, CSNP, ISNP)


Bachelor’s Degree or equivalent experience.

Business Overview

Bring your heart to CVS Health

Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

We strive to promote and sustain a culture of diversity, inclusion and belonging every day.

CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

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