Executive Director, Network Management, CVS Health

CVS Health

Location:
United States, Work At Home

Category:
Health and Beauty

Contract Type:
Employment contract

Salary:

131500.00 - 303195.00 USD / Year

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Job Description:

Executive Director role providing leadership, guidance, and oversight for network management team to ensure overall network competitiveness, service, and profitability for Michigan market. Supports Commercial, Medicare, IFP, and Medicaid businesses with provider contracting, service, strategic relationships, plan management, and value based contracting strategy.

Job Responsibility:

Leading and developing the overall network and provider relations strategy
Leading the design, development, management, and/or implementation of strategic network configurations that drive membership growth
Leading and negotiating at the C-Suite level externally and internally
Developing, directing, and maintaining relationships with external and internal care providers
Providing network strategy support to sales and marketing
Overseeing and/or negotiating the most complex, competitive contractual relationships with providers
Ensuring network adequacy and implementing actions to build out network expansion markets
Advancing the company strategy to adopt value-based payment models
Representing the organization at related external provider meetings and conferences
Working closely with Population Health resources to enable and improve clinical outcomes
Responsibility for understanding medical cost issues and medical cost ratios
Driving improvement in market provider and member satisfaction results
Ensuring responses to inquiries/issues generated by the provider service center

Requirements:

Person must reside in Michigan or be willing to relocate to Michigan
10+ years of experience in managed care
Leading and managing teams
Comprehensive understanding of hospital and physician financial issues and how to leverage technology to achieve quality and cost improvements
In-depth knowledge of various reimbursement structures and payment methodologies for both hospitals and physicians
Comprehensive understanding of value-based strategies and population health management
Strong experience building and maintaining relationships with large hospitals/provider systems, integrated delivery systems and large physician groups
May require knowledge of MACRA and other government programs
Solid leadership skills including staff development
Understands the regulatory environment and ensures contractual compliance with federal and state requirements
Bachelor's degree required/specialized training/relevant professional qualification

Nice to have:

Knowledge of MACRA and other government programs
Experience with Joint Venture alliances

What we offer:

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
No-cost wellness screenings
Tobacco cessation and weight management programs
Confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
August 27, 2025

Expiration:
September 18, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Executive Director, Network Management