Lead Director, Network Management (Remote/Michigan Based)(Medicaid) CVS Health


Remote opportunity for a Michigan-based Network professional.

Relocation is available.

The Lead Director, leads a team of Provider Relations and Contracting resources who design, develop, manage and/or implement strategic network configurations and effective managed care network relationships.

Oversees Provider Relations team(s) that manage the service needs for providers including network/provider relations policy, recruitment, education and training, as well as improved workflows.

Oversees the development of programs to maintain and enhance collaborative provider relationships and

operational effectiveness.

Manages the activities of the network development team, including effective strategies to build progressive provider partnerships.

Maintains accountability for related compliance,

quality and financial goals.

Maintains accountability for contractual relationships with providers according to prescribed financial guidelines with all provider types including at risk, IPA/IPO, hospital and large provider/provider groups.

Ensures necessary review, oversight and support network filings in compliance with state and federal regulations.

Accountable for cost arrangements and contract performance in support of network quality, availability and financial strategies to achieve cost management goals.

Ensures network coverage adequacy and implements action items to close gaps.

Responsible for advancing the adoption of value-based payment models.

Analyzes data and is responsible for understanding medical cost issues and trends; collaborates with Medical Economics to monitor and identify scorable action plans; works closely with Population Health, Quality, and Medical Management teams to enable and improve clinical outcomes.

May work with VBC Engagement managers to develop VBC arrangements and collaborative agreements.






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