Lead Director, Network Management (Texas and ...

Job DescriptionFully RemoteThe Lead Director, Network Contracting (Medicaid) will beaccountable for the strategic alignment, operational success and performance management of assigned provider relationships with the most complex/high value initiatives and/or highest risk and revenue generating provider systems, networks and value-basedrelationships for the Southwest division of Aetna Medicaid. Responsible for developing and implementing the network strategy for Southwest Division of Aetna Medicaid, in alignment with priorities of the Southwest Division President, Health Plan Leadership teams, and State Regulators. Accountable for all network performance reporting to various internal and external stakeholders, including but not limited to Health Plan Leadership teams, State Regulators, and External Quality Review Organizations (EQROs). Manage a small team of network contractingteam members. Ensure that assigned arrangements are functioningsuccessfully and working to improve quality of care while reducing costs.Proven ability to interact with, influence and collaborate with internal and external stakeholders at all levels.Experience managing matrixed environment with ability toleverage internal business partners to complete tasks.Proven track record managing complex projects and or programs that resulted in cost savings.Good interpersonal and executive presentation skills and ability to form strong provider relationships.Self-directed individual who requires minimal supervision.Demonstrated ability to problem solve independently.Pay RangeThe typical pay range for this role is:Minimum: 100,000Maximum: 221,000Please 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 QualificationsKnowledge of healthcare and insurance industry.5+ years experience in a health plan, health system or provider organization.Experience with Medicaid Managed Care.Strong knowledge of health care negotiation strategies and alternative payment models.Ability to travel up to 20%.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+ years experience in a health plan, health system or provider organization, ACO / managed-care experience preferred Mastery of Provider Contracting, Plan Design and Product Offerings, especially complex, advanced Alternative Payment ModelsKnowledge and experience in Medicaid Managed Care/value based contracting in California and TexasPreferred locations: CA or TX.EducationBachelor's degree or equivalent professional experience.Preferred Master's Degree (MBA/MHA/MPH or similar)Business 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