Lead Director, Network Management (Remote/Michigan ...

Job DescriptionRemote opportunity for a Michigan-based Network professional. Relocation is available.The Lead Director, leads a team of Provider Relations and Contracting resources who design, develop, manage and/or implement strategic network configurations and effective managed care network relationships.Oversees Provider Relations team(s) that manage the service needs for providers including network/provider relations policy, recruitment, education and training, as well as improved workflows.Oversees the development of programs to maintain and enhance collaborative provider relationships andoperational effectiveness. Manages the activities of the network development team, including effective strategies to build progressive provider partnerships. Maintains accountability for related compliance,quality and financial goals. Maintains accountability for contractual relationships with providers according to prescribed financial guidelines with all provider types including at risk, IPA/IPO, hospital and large provider/provider groups. Ensures necessary review, oversight and support network filings in compliance with state and federal regulations.Accountable for cost arrangements and contract performance in support of network quality, availability and financial strategies to achieve cost management goals.Ensures network coverage adequacy and implements action items to close gaps.Responsible for advancing the adoption of value-based payment models.Analyzes data and is responsible for understanding medical cost issues and trends; collaborates with Medical Economics to monitor and identify scorable action plans; works closely with Population Health, Quality, and Medical Management teams to enable and improve clinical outcomes.May work with VBC Engagement managers to develop VBC arrangements and collaborative agreements.Required QualificationsMedicaid knowledge in Michigan.Required to communicate w/internal/external parties by phone/in person; may require travel to offsite location.Reside in Michigan (relocation package is available).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 Qualifications8 - 10 years related experience Related experience in health operations, network relations and development, command of financials and pricing strategies, and sales interface.Experience building and maintaining relationships with provider systems.A successful track record managing and negotiating major provider contracts In depth knowledge of various reimbursement structures and payment methodologies for both hospitals and providers/providers.Knowledge and experience with value based contracting and accountable care -depth knowledge of managed care business, regulatory /legal requirements.Solid leadership skills, including staff development and talent management.EducationBachelor's degree or equivalent work experience.MBA/Masters 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: 2025-10-04