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.
**This person must sit in KY, IL, MO, MN, WI, SD, ND, IN, IA, CO, OH, KS, NE, MI**
Position Summary
This role will be accountable for the strategic alignment, operational success and performance management of assigned provider relationships with the most complex/high value initiatives and/or highest risk and revenue generating provider systems, network and value-based relationships. Ensures that assigned value based contract arrangements are functioning successfully and working to improve quality of care while reducing costs. Additionally, this position will include supervisory responsibilities for VBS Provider Performance team members.
This role is strategically designed to provide dedicated leadership and oversight for Medicaid value-based care (VBC) initiatives across the Central Region. This position carries broad responsibility for the development, execution, and oversight of Medicaid focused value-based contracting and provider performance strategies within these two key markets.
Key Responsibilities:
Provider Relationship Management - Understands the terms of the value based contract arrangements to answer questions/address issues. Responsible for establishing and maintaining productive, professional relationships.
Educates internal and external parties as needed to ensure compliance with contract terms and expectations
Coordinates and prepares for external provider meetings and ensures that the most impactful internal subject matter experts (clinical, pharmacy, financial, analytical, etc.) are utilized to optimize performance. (External meetings include JOCs, clinical meetings, Informatics discussions, contract reconciliations, etc.)
Assists with workflow development and strategies to integrate data and reporting
Works independently to manage relationships and identify/implement solutions to problems
Drives provider performance and partners with local market to ensure pathways to performance against business and team objectives
Drives improvement in deal performance for multiple lines of business, complex models, and/or advanced national provider partners
Leverages reporting/data to monitor contract performance against financial, clinical, cost and efficiency targets. Adept at identifying issues or trends in reporting.
Assumes supervisory responsibilities for VBS Provider Performance team members Identifies improvement opportunities. Provides strategy consultation on actions/tactics to make needed improvements
Assists Executive Director, Provider Performance, in developing and driving strategies to achieve organizational goals
Serves as support and back-up to Executive Director, Provider Performance, as needed
Drives and monitors consistency and adherence to policies/protocols of department
Assists in identification and promotion of best practices within Team
Identifies training and/or educational needs within Team
Oversees training plan for new Team colleagues
Required Qualifications
10 years experience in a health plan, health system or provider organization, ACO / managed-care experience preferred.
Strong understanding of Medicaid products, provider engagement, and regulatory compliance requirements.
Experience directly managing people and/or Teams
Self-directed individual with independent problem-solving skills
Proven ability to interact with, influence and collaborate with internal and external stakeholders at all levels
Experience managing matrixed environment with ability to leverage internal business partners to complete tasks
Good interpersonal and communication skills
Knowledge of healthcare and insurance industry
Ability to form strong client relationships
Preferred Qualifications
Adept at collaboration and teamwork with both internal and external partners
Experience with Provider Contracting, Plan Design and Product Offerings
Education
Bachelor's degree preferred or a combination of professional work experience and education.
Pay Range
The typical pay range for this role is:
$100,000.00 - $231,540.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Job details are sourced from the employer's original posting.
Open job postingAbout the company
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come. Excellent benefits package, including 401k, tuition, licensure and certification reimbursement. We promote healthy & wellness lifestyles and offer specialty programs here at Aetna. We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence. Together we will empower people to live healthier lives. Benefit eligibility may vary by position. Click here to review the benefits associated with this position. Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities. We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.