Description
Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. *Position Summary* The Lead Director of Value-based Contracting manages and oversees Value-based operation in compliance with our Network responsibilities within the contractual requirements as outlined below: * Accountable for building strategic relationships with our provider partners to develop innovative value-based solutions to meet total cost and quality goals . * Responsible for developing alternative payment models, identifying and planning new initiatives, and negotiating high value/risk contracts with the most complex arrangement structures, which requires: * Profound understanding the providers' volume and cost structure * Working cross functionally to identify the levers and critical negotiation points, and * Aligning negotiation strategies and tactics with goals encompassing network accessibility, quality, compliance and financial performance. * Leads work and deliverables of multiple, complex projects/programs, through assessment to implementation, that impact multiple processes, systems, functions, and products across all lines of business. * Need experience with the LAN APM Framework and have experience of evolving arrangements across the entire continuum – from Pay for Quality/Performance(P4Q) through population health payment arrangements. * Accountable for working with our strategic provider partners to develop innovative value-based solutions to meet total cost and quality goals. * Responsible for collaborative development of alternative payment models, initiative planning, and negotiating high value/risk contracts with the most complex and challenging, market/region, largest group/system or highest value/volume of spend providers 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. * Works with Practice Transformation Team, VBS reporting team and other key internal teams to develop a value based strategic plan and manage contract performance with targeted provider groups to ensure we meet guidelines for value based provider agreements. * In charge of complete value based contracting cycle from planning, creating documents, and negotiation to oversee loading of executed arrangements. That includes, but not limited to: * Recruits providers to ensure attainment of network expansion and adequacy targets. * Accountable for negotiation of payment arrangements with providers and operation ability of the established contracts. * Oversees the monitoring and loading of executed value-based provider contracts to ensure requirements. * Evaluates, helps formulate, and implements the provider network strategic plans to achieve value-based contracting targets and manage medical costs through effective value-based contracting to meet state contract and product requirements. * This Position will manage combined functions for external provider engagement representatives and internal provider relations representatives to ensure successful Provider Relations, and Network Performance including Clinical and Affordability Targeted Improvements as identified. That includes, but not limited to: * Represents company with high visibility constituents, including customers and community groups. Promotes collaboration with internal partners. * Continuous review of value based provider performance and movement of providers along the value based continuum as they are ready. * Recommend training programs and educational materials for providers as well as for internal staff and aligns Network functions with Operations and Claims as needed. * Collaborates with internal partners to assess effectiveness of tactical plan in managing costs. May optimize interaction with assigned providers and internal business partners to facilitate relationships and ensure provider needs are met. * Facilitates and attends, as needed, including Traveling externally when required for, Provider meetings and negotiations. * Coordinate's provider information with member services and other internal departments as requested. * Provides assistance and support to other departments, as needed, to obtain crucial or required information from Providers, such as HEDIS, Credentialing, Grievance and Appeals, SIU, etc. Coordinates provider status information with member services and other internal departments. *Required Qualifications* * 7+ years of related experience and comprehensive level of negotiating skills with successful track record negotiating value-based contracts with IPAs, large complex provider systems or groups. hospitals and large physician entities * Experience reviewing medical claims data and developing executive summaries and identifying opportunities for mitigating medical cost trend * Knowledge of Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and Network Performance Standards * Excellent analytical and problem-solving skills * Strong communication, negotiation, and presentation skills * Be familiar with HEDIS technical specifications and various measurable percentiles associated with the HEDIS measures. * Ability to work in a matrixed organization and gain consensus and share information to various interested parties. * Ability to travel within the state to visit providers or to main office in Aetna Office Locations applicable to the Market *Preferred Qualifications* * Familiar with legal terms in the context of provider contracting * Experience with Commercial, Medicare and Medicaid contracting * Able to apply system thinking when managing multiple provider value-based initiatives * Strong financial modeling background * Experience with Custom Relation Management applications or any other web-based tools, which have the capability of work-flow management and tracking * Resident of Pennsylvania preferred or surrounding states * *Education* * Bachelor's degree in a closely-related field or an equivalent combination of formal education and recent, related experience. *Pay Range* The typical pay range for this role is: $100,000.00 - $231,500.00 This 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. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit [jobs.CVSHealth.com/benefits](https://jobs.cvshealth.com/benefits) We anticipate the application window for this opening will close on: 06/30/2024CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work. CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through [ColleagueRelations@CVSHealth.com](mailto:ColleagueRelations@CVSHealth.com) If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.
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