CVS Health
Lead Director, Payer Relations
CVS Health, Springfield, Illinois, us, 62777
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 (LD), Payer Relations, will have the opportunity to change health care across this country. This work has a purpose; the capacity to strengthen the financial stability of some of our most important health care partners and improve the quality of life of thousands of patients. As the Lead Director, part of the CVS Accountable Care segment at CVS Health, you will be an integral part of a high-performing and dynamic Partner Success team driving value-based care forward.
The Lead Director, under the direction of the VP of Payer Relations, will oversee existing Medicare Advantage payor programs and the expansion into new service lines including commercial and government programs. S/he will manage all aspects of the payor’s Value-based Care program from the development to implementation to operational phases and will be responsible for nurturing and expanding the relationship with CVS Accountable Care’s Payer Partners. The LD will work closely across the Company to ensure the program meets the defined objectives as set forth by CVS Accountable Care and Provider and Payor Partners.
To be successful, this individual will develop and execute on a strategy that will seamlessly bridge the gap to CVS Accountable Care’s Provider Delivery Team to ensure the Payer and program objectives are accomplished, while alleviating provider administrative burden. Serving as a consultative resource for contracting and Provider performance discussions, this role will enable successful execution and business results. Additionally, this individual will work cross-functionally with CVS Health’s broader Health Care Delivery business unit to support holistic solutions to serve our partners.
The candidate will have prior Healthcare experience, a high level of intellectual curiosity, and a proactive attitude to take on new challenges and manage through complexity. You will thrive in an entrepreneurial environment, excel at relationship management, and have deep experience with executive-level communication and data storytelling.
Note: This is a remote role and can be anywhere in the continental United States
Essential Duties and Responsibilities:
● Partner with Payers to set the strategy for their provider engagements, inclusive of workflows, incentives, resources, population health and relationships
● Manage executive relations between Payer’s at the National and Market level, while coordinating execution with provider executives and key CVS internal stakeholders
● Grow and expand eligible payer member base, upselling to more lives, greater risk, increased engagement, and geographic expansion
● Lead the payer and provider partner perspective as it relates to product and business development functions
● Own the strategic roadmap for payer engagement in the ACO while syncing with emerging HCD-wide coordination efforts
● Drive strategic positioning of MLR, Stars and Risk targets, while identifying the associated incentives and tactical workflows
● Facilitates and leads regularly recurring Payor meetings to tightly manage key performance indicators and use this data to identify structures and functions necessary for successful implementation and execution of value-based programs.
● Owns the service design for multi-payer value-based care programs, in collaboration with the VP of Partner Success and other cross-functional teams.
● Assesses market landscape to achieve understanding of payor dynamic, Provider programs, strategic goals, and operating environment to facilitate service delivery.
● Serves as the value-based care program subject matter expert to internal CVS Health stakeholders, evaluates provider business operations, and shares strategic ideas to drive improvement.
● Continuously assesses and adapts service delivery plans to evolving partner needs and business requirements.
● Participate in Payor and provider onboarding as needed to deliver content and begin to build personal and professional relationships.
● Identifies structures and functions necessary for successful implementation of value-based programs.
● Other duties as assigned by the VP of Partner Success
Qualifications:
● 10+ years of experience in one or more of the following: population health management, value-based care arrangements, provider networks, managed care operations, network contracting, practice management, health systems management, healthcare management consulting, service line strategy, quality improvement services
● Strong understanding of Medicare, Medicare Advantage, and Commercial payment models including clinical quality metrics and quality programs/initiatives
● Prior experience in Accountable Care Organizations (ACO), Medicare Shared Savings Program (MSSP), ACO REACH, or other value-based care arrangements, especially Medicare Advantage.
● Demonstrated ability to create and deliver compelling presentations that effectively communicate information and ideas.
● Experience designing and implementing programs in healthcare environment consisting of resource strategies and operational processes to achieve results.
● Strong financial acumen and data literacy (Microsoft Excel experience)
● Ability to travel as needed (estimate average of 1-2x monthly to launches, on-site strategy and partnership meetings, business development opportunities, and other training and educational events as requested).
● Consulting experience or consultative mindset with demonstrated ability to solve complex business problems and ability to navigate ambiguity.
● Relationship building ability in matrixed environments with senior leaders.
Education
Bachelor's degree from an accredited four-year college or university: Business, Business Administration, Health care, Health Care Administration, Public Health, or related field. Advanced degree such as M.B.A., M.P.H., or M.H.A., strongly preferred.
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.
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 Health (https://jobs.cvshealth.com/us/en/benefits)
We anticipate the application window for this opening will close on: 12/31/2024
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
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 (LD), Payer Relations, will have the opportunity to change health care across this country. This work has a purpose; the capacity to strengthen the financial stability of some of our most important health care partners and improve the quality of life of thousands of patients. As the Lead Director, part of the CVS Accountable Care segment at CVS Health, you will be an integral part of a high-performing and dynamic Partner Success team driving value-based care forward.
The Lead Director, under the direction of the VP of Payer Relations, will oversee existing Medicare Advantage payor programs and the expansion into new service lines including commercial and government programs. S/he will manage all aspects of the payor’s Value-based Care program from the development to implementation to operational phases and will be responsible for nurturing and expanding the relationship with CVS Accountable Care’s Payer Partners. The LD will work closely across the Company to ensure the program meets the defined objectives as set forth by CVS Accountable Care and Provider and Payor Partners.
To be successful, this individual will develop and execute on a strategy that will seamlessly bridge the gap to CVS Accountable Care’s Provider Delivery Team to ensure the Payer and program objectives are accomplished, while alleviating provider administrative burden. Serving as a consultative resource for contracting and Provider performance discussions, this role will enable successful execution and business results. Additionally, this individual will work cross-functionally with CVS Health’s broader Health Care Delivery business unit to support holistic solutions to serve our partners.
The candidate will have prior Healthcare experience, a high level of intellectual curiosity, and a proactive attitude to take on new challenges and manage through complexity. You will thrive in an entrepreneurial environment, excel at relationship management, and have deep experience with executive-level communication and data storytelling.
Note: This is a remote role and can be anywhere in the continental United States
Essential Duties and Responsibilities:
● Partner with Payers to set the strategy for their provider engagements, inclusive of workflows, incentives, resources, population health and relationships
● Manage executive relations between Payer’s at the National and Market level, while coordinating execution with provider executives and key CVS internal stakeholders
● Grow and expand eligible payer member base, upselling to more lives, greater risk, increased engagement, and geographic expansion
● Lead the payer and provider partner perspective as it relates to product and business development functions
● Own the strategic roadmap for payer engagement in the ACO while syncing with emerging HCD-wide coordination efforts
● Drive strategic positioning of MLR, Stars and Risk targets, while identifying the associated incentives and tactical workflows
● Facilitates and leads regularly recurring Payor meetings to tightly manage key performance indicators and use this data to identify structures and functions necessary for successful implementation and execution of value-based programs.
● Owns the service design for multi-payer value-based care programs, in collaboration with the VP of Partner Success and other cross-functional teams.
● Assesses market landscape to achieve understanding of payor dynamic, Provider programs, strategic goals, and operating environment to facilitate service delivery.
● Serves as the value-based care program subject matter expert to internal CVS Health stakeholders, evaluates provider business operations, and shares strategic ideas to drive improvement.
● Continuously assesses and adapts service delivery plans to evolving partner needs and business requirements.
● Participate in Payor and provider onboarding as needed to deliver content and begin to build personal and professional relationships.
● Identifies structures and functions necessary for successful implementation of value-based programs.
● Other duties as assigned by the VP of Partner Success
Qualifications:
● 10+ years of experience in one or more of the following: population health management, value-based care arrangements, provider networks, managed care operations, network contracting, practice management, health systems management, healthcare management consulting, service line strategy, quality improvement services
● Strong understanding of Medicare, Medicare Advantage, and Commercial payment models including clinical quality metrics and quality programs/initiatives
● Prior experience in Accountable Care Organizations (ACO), Medicare Shared Savings Program (MSSP), ACO REACH, or other value-based care arrangements, especially Medicare Advantage.
● Demonstrated ability to create and deliver compelling presentations that effectively communicate information and ideas.
● Experience designing and implementing programs in healthcare environment consisting of resource strategies and operational processes to achieve results.
● Strong financial acumen and data literacy (Microsoft Excel experience)
● Ability to travel as needed (estimate average of 1-2x monthly to launches, on-site strategy and partnership meetings, business development opportunities, and other training and educational events as requested).
● Consulting experience or consultative mindset with demonstrated ability to solve complex business problems and ability to navigate ambiguity.
● Relationship building ability in matrixed environments with senior leaders.
Education
Bachelor's degree from an accredited four-year college or university: Business, Business Administration, Health care, Health Care Administration, Public Health, or related field. Advanced degree such as M.B.A., M.P.H., or M.H.A., strongly preferred.
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.
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 Health (https://jobs.cvshealth.com/us/en/benefits)
We anticipate the application window for this opening will close on: 12/31/2024
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.