At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.
As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

POSITION SUMMARY

Provides strategic leadership and oversight for network management and provider relations. Develops and implements network strategies, manages provider contracts and negotiations, monitors provider performance metrics, leads dispute resolution processes, and collaborates with key stakeholders to drive network growth and ensure high-quality provider relationships

REQUIRED QUALIFICATIONS

• A minimum of 10 years professional work experience in provider network management.
• A minimum of 3 years in a management role leading others.
• Must have experience with both fee for service and value-based care contracting.
• Adept at execution and delivery (planning, delivering, and supporting) skills
• Adept at business intelligence
• Adept at collaboration and teamwork
• Mastery of problem solving and decision making skills
• Mastery of growth mindset (agility and developing yourself and others) skills

PREFERRED QUALIFICATIONS

• Strong analytical skills and operating system efficiency.

EDUCATION

• Bachelor’s degree preferred or a combination of professional work experience and education.

• Oversees key Network Management contracting activities, including negotiating fee schedules, reimbursement rates, and contract terms and conditions.
• Controls the development and expansion of the company’s provider network by evaluating potential network providers, negotiating contracts, and establishing relationships with healthcare providers to ensure a comprehensive and high-quality network.
• Contributes to optimizing the network’s performance and effectiveness by analyzing network data, utilization patterns, and market trends to identify opportunities for network enhancements, cost savings, and improved access to care.
• Manages the performance of network providers, including tracking key performance indicators, analyzing provider performance data, and implementing performance improvement initiatives.
• Conducts market analysis, assesses competitive landscapes, and makes recommendations for network expansion strategies.
• Develops training sessions and communicates updates related to network management, utilization management, claims processing, and other relevant topics.
• Communicates findings to executive leadership and stakeholders, identifying opportunities for improvement and cost containment.
• Manages operational aspects of the team, subsequently implementing workforce and succession plans to meet business goals and objectives.
• Guides management for individual performance evaluations aimed to provide critical feedback for skills development and depth of work area experience.