Lead Director, Network Management

We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary: The Kentucky Network Lead Director will be accountable for developing strategic partnerships for the Kentucky Medicaid Health Plan. Strong focus on designing conceptual models, initiative planning, and negotiating high value contracts with the most complex and challenging hospital systems, integrated delivery systems and large groups in accordance with company standards in order to maintain and enhance provider networks, while working cross functionally to ensure consistency with all contracting strategies and meeting and exceeding accessibility, quality, compliance, and financial goals and cost initiatives. Contracting responsibilities include Medicaid. Key focus on building strong relationships with providers as well as developing and executing contract strategies and yield market leading discount and cost positions for Aetna as well as value-based relationships that improve the quality and financial performance of Aetna's networks for its members. Responsibilities include negotiation and management of various value based payment models and management of contract performance associated with these models with key focus on provider engagement. Recruit providers as needed to ensure attainment of network expansion and adequacy targets. Accountable for cost arrangements within defined groups. Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities. Responsible for identifying and managing cost issues and collaborating cross functionally to execute significant cost saving initiatives. Represents company with high visibility constituents, including customers and community groups. Promotes collaboration with internal partners. Evaluates, helps formulate, and implements the provider network strategic plans to achieve contracting targets and manage medical costs through effective provider contracting to meet state contract and product requirements. Collaborates with internal partners to assess effectiveness of tactical plan in managing costs. Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information. Helps mentor and develop others within the department by providing shadowing opportunities and acting as a subject matter expert.