Lead Director, Network Management (Value-Based Care)

4062 Aetna Resources, LLC; Illinois; Hybrid; USD 100,000 - 232,000; Full time

Benefits offered by this job

Bonus eligible

Equity awards

Comprehensive benefits

Job summary

CVS Health is seeking a leader to manage Medicaid value-based provider relationships and drive performance across complex networks in the Central Region. The role entails oversight of contracts, data analytics and steering cross-functional teams to reduce costs while maintaining high quality care.

You will supervise the VBS Provider Performance team, shape strategy with senior leaders, and ensure adherence to policies while promoting best practices across the network.

Qualifications

• 10 years experience in a health plan, health system or provider organization.
• Strong understanding of Medicaid products, provider engagement, and regulatory requirements.
• Experience directly managing people and/or teams.
• Excellent interpersonal and communication skills.

Responsibilities

• Manage provider relationships and ensure contract terms are met.
• Coordinate external provider meetings with clinical, pharmacy, financial, and analytical teams.
• Drive provider performance across multiple lines of business and complex models.
• Lead and supervise the VBS Provider Performance team and support strategic initiatives.

Skills

Medicaid knowledge

Provider engagement

Regulatory compliance

People management

Stakeholder collaboration

Data reporting

Education

Bachelor's degree preferred

Job description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

This person must sit in KY, IL, MO, MN, WI, SD, ND, IN, IA, CO, OH, KS, NE, MI

Position Summary

This role will be accountable for the strategic alignment, operational success and performance management of assigned provider relationships with the most complex/high value initiatives and/or highest risk and revenue generating provider systems, network and value-based relationships. Ensures that assigned value based contract arrangements are functioning successfully and working to improve quality of care while reducing costs. Additionally, this position will include supervisory responsibilities for VBS Provider Performance team members. This role is strategically designed to provide dedicated leadership and oversight for Medicaid value-based care (VBC) initiatives across the Central Region. This position carries broad responsibility for the development, execution, and oversight of Medicaid focused value-based contracting and provider performance strategies within these two key markets.

Key Responsibilities

Provider Relationship Management - Understands the terms of the value based contract arrangements to answer questions/address issues. Responsible for establishing and maintaining productive, professional relationships. Educates internal and external parties as needed to ensure compliance with contract terms and expectations Coordinates and prepares for external provider meetings and ensures that the most impactful internal subject matter experts (clinical, pharmacy, financial, analytical, etc.) are utilized to optimize performance. (External meetings include JOCs, clinical meetings, Informatics discussions, contract reconciliations, etc.) Assists with workflow development and strategies to integrate data and reporting Works independently to manage relationships and identify/implement solutions to problems Drives provider performance and partners with local market to ensure pathways to performance against business and team objectives Drives improvement in deal performance for multiple lines of business, complex models, and/or advanced national provider partners Leverages reporting/data to monitor contract performance against financial, clinical, cost and efficiency targets. Adept at identifying issues or trends in reporting. Assumes supervisory responsibilities for VBS Provider Performance team members Identifies improvement opportunities. Provides strategy consultation on actions/tactics to make needed improvements 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 department Assists in identification and promotion of best practices within Team Identifies training and/or educational needs within Team Oversees training plan for new Team colleagues

Required Qualifications

10 years experience in a health plan, health system or provider organization, ACO / managed-care experience preferred. Strong understanding of Medicaid products, provider engagement, and regulatory compliance requirements. Experience directly managing people and/or Teams Self-directed individual with independent problem-solving skills Proven ability to interact with, influence and collaborate with internal and external stakeholders at all levels Experience managing matrixed environment with ability to leverage internal business partners to complete tasks Good interpersonal and communication skills Knowledge of healthcare and insurance industry Ability to form strong client relationships

Preferred Qualifications

Adept at collaboration and teamwork with both internal and external partners Experience with Provider Contracting, Plan Design and Product Offerings

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.

Great benefits for great people

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. 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, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 10/10/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.