[Hiring] Lead Director, Value-Based Contracting @CVS Health

Role Description

The Lead Director of Value-Based Contracting is responsible for establishing and maintaining productive value-based relationships with key network providers. Responsible to develop and manage the Value-based Network for a Region as outlined below:

• Accountable for building strategic relationships with 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 complex arrangement structures, which requires:
  • Understanding providers’ volume and cost structure.
  • Working cross-functionally to identify levers and critical negotiation points.
  • Aligning negotiation strategies and tactics with network accessibility, quality, compliance, and financial performance goals.
• In charge of the complete value-based contracting cycle from planning, creating documents, negotiation, and loading of executed arrangements.
• Works with Performance team, Clinical Transformation team, VBS Analytics team, and other key internal teams to develop a value-based strategic plan and oversee contract performance with targeted provider groups to ensure objectives for value-based provider agreements are met.
• Evaluates, helps formulate, and implements network strategic plans to achieve value-based contracting targets and manage medical costs through effective value-based contracting.
• Provides assistance and support to other departments, as needed, to obtain crucial or required information from providers, such as HEDIS, Credentialing, etc.
• Leads work and deliverables of complex projects/programs, through assessment to implementation, that may impact multiple processes, systems, functions, and products across all lines of business.
• Facilitates and attends external provider meetings and negotiations, as needed.
• Manages Value-Based ACO products (Aetna Whole Health local networks); this may include day-to-day management in addition to the contracting of ACO product deal terms.
• Assumes supervisory responsibilities for VBC contracting team members.
• 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 the department.
• Assists in identification and promotion of best practices within the Team.
• Identifies training and/or educational needs within the Team.
• Oversees training plan for new Team contracting colleagues.

Qualifications

• 10+ years of related experience and comprehensive level of negotiating skills with a successful track record negotiating value-based contracts with IPAs, large complex provider systems or groups, hospitals, and large physician and risk-bearing entities.
• Experience developing executive summaries and identifying opportunities for mitigating medical cost trends.
• Excellent analytical and problem-solving skills.
• Strong communication, negotiation, and presentation skills.
• Ability to work in a matrixed organization and gain consensus and share information with various interested parties.

Requirements

• Familiar with legal terms in the context of provider contracting.
• Familiar with CMS Stars and HEDIS technical specifications and various measurable percentiles associated with the HEDIS measures.
• Experience with Commercial, Medicare, and Individual Exchange contracting.
• Able to apply system thinking when managing multiple provider value-based initiatives.
• Strong financial modeling background.

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 - $231,540.00. 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.

Benefits

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.
• Other resources, based on eligibility.