Director, Medical Pharmacy Network Strategy

Hispanic Alliance for Career Enhancement; Kentucky; Hybrid; USD 100,000 - 232,000; Full time

Benefits offered by this job

Bonus eligibility

Equity program

Competitive benefits

Job summary

CVS Health is seeking a seasoned leader to drive network strategy and improvement of medical drug reimbursement across hospital and regional provider partners. You will guide market contracting, analytics, and best practices to improve cost, quality and access outcomes.

With deep experience in health plan operations and provider networks, you will influence senior leadership, manage cross-functional programs, and ensure regulatory compliance while aligning strategy with broader pharmacy

Qualifications

• At least 10 years of experience in health plan operations, network contracting, or provider-facing contracting environments.
• At least 3 years of experience in a health plan setting, with exposure to payer operations and healthcare administration.
• Demonstrated ability to translate complex contracting, financial, and operational information into concise, executive-level narratives that drive informed decision‑making, align stakeholders, and communicate business value effectively.
• Proven ability to critically evaluate contract terms, reimbursement structures, and business proposals, confidently challenging unfavorable provisions and advocating for solutions that mitigate risk, protect organizational interests, and support long‑term strategic objectives.
• Demonstrated knowledge of medical pharmacy reimbursement and outpatient reimbursement models, including payer and provider considerations.

Responsibilities

• Develop Market Network contract relationships providing support for market agreements/negotiations with health systems, hospitals and regional provider groups.
• Align broader medical pharmacy strategy with National Ancillary Network & Value-Based Care teams.
• Designs strategic retail network initiatives and plans by analyzing market trends, assessing competitive advantages, and identifying opportunities to grow the network's effectiveness and efficiency.
• Defines programs to ensure alignment and integration of the provider network strategy with overall business objectives, collaborating with operations, marketing, and finance.
• Controls all systems that monitor the performance of the medical pharmacy / infusion provider network, subsequently analyzing key performance indicators and identifying specific areas for improvement.
• Communicates with external stakeholders, including healthcare organizations and insurance providers, to establish partnerships and collaborative arrangements.
• Aligns retail provider network strategies with legal and regulatory frameworks, ensuring critical compliance with all relevant health regulations and standards.
• Advises senior management and stakeholders on provider network performance, patient expectations and outcomes, and key financial metrics and targets.
• Designs key strategies for retail network performance and partners with market leaders to ensure business plan requirements and team objectives are consistently met.

Skills

Contract negotiation

Health plan operations

Analytics & reporting

Executive communication

Regulatory compliance

Provider network strategy

Education

Bachelor's degree preferred

Job description

CVS Health is seeking a seasoned leader to drive network strategy and improvement of medical drug reimbursement across hospital and regional provider partners. You will guide market contracting, analytics, and best practices to improve cost, quality and access outcomes.

With deep experience in health plan operations and provider networks, you will influence senior leadership, manage cross-functional programs, and ensure regulatory compliance while aligning strategy with broader pharmacy