Lead Director, Network Relations Management

CVS Health

6d • $100,000 - $231,540

About The Position

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 Lead Director will be accountable for developing strategic partnerships to ensure Aetna has market leading discount and cost positions and high value, competitive networks. 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 Medicare and Commercial. Leads Provider Relations Operations & Network Strategy: Oversees teams responsible for building and managing relationships with existing and new providers across assigned geographies. Directs network development for Commercial and Medicare products, including contracting, retention, provider servicing, and ensuring compliance with policies and standards. Drives Cross‑Functional Collaboration & Operational Excellence: Partners with internal departments to implement complex provider contracts, support reimbursement methodologies, resolve billing issues, and address medical cost drivers. Serves as the primary liaison for regulatory audits, credentialing requirements, grievance and appeals monitoring, and ensures timely, compliant issue resolution. Manages Provider Education, Communication & Engagement: Develops and executes provider communication strategies including newsletters, notifications, forums, and orientations. Ensures consistent delivery of education on new protocols, policies, and contract requirements. Oversees maintenance of provider resources such as portals, directories, and manuals; represents Provider Relations in community, sales, and marketing initiatives. 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. 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. Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information. Guides management for individual performance evaluations aimed to provide critical feedback for skills development and depth of work area experience.

Requirements

• A minimum of 10 years of progressively responsible experience in provider relations, contracting, or healthcare operations, demonstrating expertise in managing provider networks, negotiating agreements, improving operational processes, and fostering collaborative relationships with internal and external stakeholders.
• A minimum of 3 years of people management experience, demonstrating the ability to lead, coach, and develop teams; manage performance; foster engagement; and drive operational excellence through effective leadership practices.
• Demonstrated knowledge of value-based contracting structures, including negotiation and implementation of agreements that align cost, quality, and performance outcomes across stakeholders.
• Experience with Medicare, Commercial contracting and various reimbursement methodologies.
• Demonstrated ability to build, manage, and grow strategic relationships that advance long-term organizational goals.
• Experience presenting complex information to groups in a clear, concise, and persuasive manner, adapting style and content to audience needs.

Nice To Haves

• Proven working knowledge of provider financial issues and competitor strategies.

Responsibilities

• Developing strategic partnerships to ensure Aetna has market leading discount and cost positions and high value, competitive networks.
• 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.
• Overseeing teams responsible for building and managing relationships with existing and new providers across assigned geographies.
• Directing network development for Commercial and Medicare products, including contracting, retention, provider servicing, and ensuring compliance with policies and standards.
• Partnering with internal departments to implement complex provider contracts, support reimbursement methodologies, resolve billing issues, and address medical cost drivers.
• Serving as the primary liaison for regulatory audits, credentialing requirements, grievance and appeals monitoring, and ensures timely, compliant issue resolution.
• Developing and executes provider communication strategies including newsletters, notifications, forums, and orientations.
• Ensuring consistent delivery of education on new protocols, policies, and contract requirements.
• Overseeing maintenance of provider resources such as portals, directories, and manuals; represents Provider Relations in community, sales, and marketing initiatives.
• Negotiation and management of various value based payment models and management of contract performance associated with these models with key focus on provider engagement.
• Identifying and managing cost issues and collaborating cross functionally to execute significant cost saving initiatives.
• Representing company with high visibility constituents, including customers and community groups.
• Ensuring resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.
• Guiding management for individual performance evaluations aimed to provide critical feedback for skills development and depth of work area experience.

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Director