Lead Director, Network Management (Medicaid LTSS)TEXAS

Job DescriptionThe Lead of Medicaid Long-Term Services and Supports (MLTSS) will provide day to day leadership of a growing Texas Medicaid Network Operations across multiple markets. The Lead Director will lead a network team that will provide high touch provider engagement to LTSS provider (i.e., Nursing Facilities and Intellectual and Developmental Disability and Behavioral Health Providers (IDD). This includes strategic and operational emphasis in fee for service payment reimbursement, value-based agreements, compliance functions and/or cost management efforts. The leader will report to the Executive Director of Network Development and collaborate across the enterprise to ensure that objectives are aligned, business strategies are delivered and financial, compliance and quality objectives are met. The Lead Director will serve as a subject matter expert and advisor to internal partners across various functionsDevelops and presents value proposition; presents the potential for network performance results. Demonstrated successful management of large-scale programs management including the following: drive strategic growth and enhancement of SNF and IDD payment models and operational capabilities; partner with the segment leadership in the development of short-term and long-term strategic plans required for Aetna's ongoing growth and success in the LTSS Medicaid segment.Ensure that processes are aligned with the highest quality standards required by - Accreditation and Credentialing Organizations (for example, NCQA, etc.)Oversee and ensure compliance with all applicable Federal and State regulations relevant to the plans function.Develop and maintain tools and processes for proactive monitoring or all relevant quality and compliance performance metrics.Partner effectively with Medicaid operational and clinical services operations to meet all LTSS requirements.Ensure that processes are aligned with the highest quality standards required by - Accreditation and Credentialing Organizations (for example, NCQA, etc.)Manage operations staff and develop workforce and organization: Lead recruitment and operating model development to meet operational growth needs; develop and implement staffing models that are consistent, cost effective meeting all compliance obligations; collaborate with health plan operations and state Medicaid agency's building a transparent and trusting relationship, meeting all state objectives; lead, develop, motivate, and manage a high performing team to meet organizational goals and objectives while effectively managing change.Lead effectively in a matrixed environment with critical business functions provided by shared service divisions (Engagement Hubs, Network)Foster an environment that supports professional development, mobility, and operational excellence.Required QualificationsProven work experience in Medicaid Managed Care Long Term Care / Long Term Services and Supports (LTSS) program management.Prior experience in managing Skilled Nursing Facilities (SNF) and/or IDD Providers, including claims payment processing, contracting and credentialing10+ years' experience in a leadership capacity and managing people8+ years' experience with Medicaid and/or a Medicaid LTSS Care Management product.Required to communicate w/internal/external parties by phone/in personRequires travel to offsite locations in the State of Texas.COVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred QualificationsRelated experience in health operations, network relations and development, command of financials and claim pricing strategies, and sales interface.Experience building and maintaining relationships with Long-Term Services and Supports (MLTSS) ProvidersA successful track record managing and negotiating major provider contracts In depth knowledge of various reimbursement structures and payment methodologies for LTSS providers.Knowledge and experience with value based contracting and accountable care -depth knowledge of managed care business, regulatory /legal requirements.EducationBachelor's degree or equivalent work experience; MBA/Master's degree preferredBusiness OverviewBring your heart to CVS HealthEvery 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.

Created: 2025-09-06