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Position Summary
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 our 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 the most complex arrangement structures, which requires:
understanding providers’ volume and cost structure
working cross functionally to identify the levers and critical negotiation points
aligning negotiation strategies and tactics with network accessibility, quality, compliance, and financial performance goals
In charge of 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 we meet objectives for value-based provider agreements.
Evaluates, helps formulate, and implements network strategic plans to achieve value-based contracting targets and manage medical costs through effective value-based contracting.
Provide 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.
Manage 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 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 contracting colleagues.
Required Qualifications
10+ years of related experience and comprehensive level of negotiating skills with 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 trend
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 to various interested parties
Preferred Qualifications
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.
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.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.