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, Network and Trend Optimization and Growth Strategy serves as a pivotal liaison between Network, Finance, Clinical Operations, and Sales Teams. This role is responsible for identifying and implementing opportunities to enhance cost efficiency and quality performance within the region. The incumbent will collaborate closely with the Network's data and analytics teams to analyze healthcare cost trends and leverage resources effectively to maximize results. This role is responsible for collaborating with Network teams ensuring competitive provider networks, proactively monitoring healthcare cost and utilization trends. Additionally, this role will work with sales teams in top-tier priority markets to develop strategies that improve our network's cost position and engage with commercial stakeholders.**Position may be remote or hybrid depending on the location of the candidates.Key Responsibilities:
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Manage medical cost by partnering with Provider Contracting, MEU, Pharmacy, Claims Cost Management, Innovation, and Clinical to ensure aggressive management of medical cost trends to achieve the best price for our products and services.Strategic Collaboration
Act as the primary point of contact for the Southeast Region between network, medical economics, clinical operations, finance team, and sales teams to align financial strategies with clinical objectives and market needs. Develop and execute strategic initiatives through pricing, network curation, and medical management that lead to sustainable long-term growth and revenue.Market Network Strategies
- Develop and implement strategies to align with network contracting priorities with commercial trend management goals.
- Ensure the organization maintains competitive network arrangements to support cost-effective and high-quality care delivery.
- Serves as the primary point of contact between Network Contracting and Commercial Teams for the Region.
- Collaborate with network teams, and sales to improve cost positions in core markets.
- Leverage high-value networks and innovative payment models to enhance care affordability and access.
- Identify and execute meaningful initiatives to mitigate trends and provide competitive products.
- Track and analyze industry trends and healthcare utilization benchmarks.
- Provide actionable insights to contracting teams to ensure strategic decision-making.
- Maintain rigorous discipline in reviewing and anticipating trends.
- Collaborate with Local Market Trend Committees and National Commercial Trend Committees.
- Partner with sales teams in top-tier priority markets to develop strategies that improve our network's cost position and support commercial objectives.
- Participate in high-level meetings with network leadership and commercial stakeholders to present findings, propose initiatives, and drive decision-making processes.
- Act as a subject matter expert in network performance and trends for the Region.
- Establish and oversee key performance indicators (KPIs) to track the success of implemented strategies and ensure continuous improvement. This position will play a pivotal role in achieving strategic priorities aligned with Aetna's focus:
- Develop and deliver regular updates to leadership on network performance and trend analysis.
- Create dashboards and reports that track progress toward achieving key performance indicators.
- Supporting commercial stakeholders and priority market needs to align network cost strategies with growth objectives.
- Minimum of 7-10 years in healthcare industry experience, network management, network contracting, actuarial, underwriting, finance, clinical operations, trend analytics and/or related field.
- Strong understanding of healthcare systems, reimbursement models, healthcare cost trends, network contracting principles, and/or provider relations
- Proven ability to analyze and interpret complex data sets to develop actionable strategies.
- At least 5 years in a role involving cross-functional collaboration.
- Strong communication skills, including experience presenting to senior leadership.
- Strong analytical abilities with proficiency in data interpretation and financial modeling.
- Proven track record of implementing cost-saving initiatives without compromising quality of care.
- Ability to influence and drive change within a complex organizational structure.
- Experience working with sales teams and commercial stakeholders.
- Experience with healthcare data analytics platforms and electronic health record (EHR) systems.
- Knowledge of regional healthcare regulations and reimbursement models.
- Certification in healthcare finance or management (e.g., HFMA, ACHE).
- Bachelor's degree preferred/specialized training/relevant professional qualification
The typical pay range for this role is:$100,000.00 - $231,540.00
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 Benefits | CVS HealthWe anticipate the application window for this opening will close on: 03/10/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.