Executive Director, Network Management

Job DescriptionThe Medicaid Chief Network (CNO) leader will be accountable for developing, implementing and monitoring Network strategy for Markets within assigned Medicaid Health Plans. This position will focus on optimizing network performance, such as meeting targeted medical cost and quality metrics, delivering on strategic network goals within markets, meeting and/or exceeding network access requirements and managing day-to-day network employees for the division. The Medicaid Network CNO leader is responsible for network and operational infrastructure within targeted Health Plans to align cost related levers and ensuring the market network(s) meet cost metrics, adequacy standards, network compliance regulations, and profitability goals. Additionally, responsible for setting Medicaid network strategy and budget for contracting across all provider types and product segments, pushing innovation across traditional and non-traditional models for all lines of business, coordinating expansion activities, and driving towards local market and national goals. Oversees and assists in the direction of local market provider relations including directing implementation and operations of Value Based Contracting arrangements while providing oversight for the other markets in the division. S/he will continually evaluate division and market financial and network performance, manages medical costs in close partnership with Clinical Functions and drives change to improve both, affordability and quality improvement. S/he needs to develop and maintain strong relationships with the Medicaid Division Leaders including the Market Senior Leaders and other Segment Leads in order to ensure alignment in developing and effecting strategies that drive profitable membership growth at the market and territory level. It is expected this position will coordinate and/or align Medicaid Network Strategies with Network Leaders overseeing respective Commercial and/or Medicare Lines of Business.S/he will be responsible for developing the key Medicaid Network messages and talking points to the external community and represent the Company at key meetings, conferences and negotiations.The leader will foster tighter alignment, integration and shared goals with the Medicaid Markets organization and our national Network Strategy and Provider Experience organization for the Division. Additionally, s/he will manage a diverse team of highly skilled network market heads, network managers, contract negotiators and other professionals.Key expectations for this role are:- Set Network vision and goals for the Medicaid Health Plans. - Drive Value Base Care Incentives within Network Provider Agreements.- Create a customer focused culture and collaborates across the organization to ensure internal and external constituent needs are met.- Operate as a change leader suggesting new approaches to drive competitive cost positioning and network innovation; breaks down barriers across the organization in order to achieve results and drive innovation.- Establish a reputation as a thought leader and trusted business partner by provider, consultant, and employer stakeholders.- Create continuous organizational improvement within assigned network employees by driving network employee performance including development plans and succession planning. - Demonstrate and maintain comfort working with external audiences including C-suite level executives including facilitating meetings, delivering presentations and conducting negotiations with major provider systems.- Empower the Regional Network Contracting Manager(s) to be the lead in complex negotiations and viewed as the external face of Aetna in their assigned geography.The role reports to the Vice President of Medicaid Networks. Candidate will reside in one of the Markets within their respective DivisionPay RangeThe typical pay range for this role is:Minimum: 131,500Maximum: 289,300Please 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 QualificationsResponsibilities include but are not limited to oversight and leadership of the following: A minimum of 15 years of healthcare experience including contracting, medical economics and field or national network experience and/or managing multiple states. Experience contracting with providers and hospital systems. Strong presentation and communication skills; ability to consult as well as negotiate. Strong analytical skills including root cause analysis. Ability to think strategically. Skilled at collaborating and working across a complex matrixed organization. Management experience managing large, dispersed, highly skilled professional teams. Overall accountability for outcomes and deliverables for the Health Plans including segment growth objectives. Ownership of Division and local market specific MER, P-model, SAI, VBC strategy, and unit cost management. Provides oversite and ownership with meeting and/or exceeding Medicaid Division Regulatory Compliance requirements including Market Network Access Standards within Networks. Ensure all contracting efforts with hospital/provider systems deliver appropriate outcomes, include Preferred and/or Acceptable (PADU) contracting methodologies. Support enterprise initiatives that leverage CVS integrated assets (e.g., Health Hubs, Aetna Connected Plan, etc). Close collaboration and alignment with Clinical and other Key Function Leaders. Represent Aetna to the legislative, regulatory and community partners; improve public relations; and, manage regional public policy issues as requested. Active engagement in the development and assessment of internal policies impacting Providers and Network. Coaches, mentors, and manages performance of team members; drives talent development and actively builds bench for key roles; direct manager for Chief Network Officers. Ensure all operational teams deliver objectives. Manage the department budget.Preferred Qualifications Expertise in market level management, cost drivers and levers, and knowledge of economic, regulatory and marketplace issues.EducationA Bachelor's degree or equivalent experience required.Business OverviewBring 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. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

Created: 2025-11-15