Lead Director, Network Management (Kentucky)

Position Summary The Kentucky Network Lead Director at CVS Health® will be accountable for developing strategic partnerships for the Kentucky Medicaid Health Plan. The role focuses on designing conceptual models, initiating strategic planning, negotiating high‑value contracts with complex hospital systems and integrated delivery networks, and enhancing provider networks while aligning with company compliance, quality, and financial objectives. Responsibilities Negotiate and manage value‑based payment models and contract performance for Medicaid and behavioral health providers. Recruit and engage providers to achieve network expansion and adequacy goals. Collaborate cross‑functionally to develop provider compensation, pricing, and contractual information. Analyze reports for negotiation and reimbursement modeling and execute significant cost‑saving initiatives. Resolve escalated issues regarding claims payment, contract interpretation, and provider information accuracy. Represent the company to external constituents and develop internal collaboration initiatives. Mentor and develop department staff through shadowing and subject‑matter expertise. Implement provider network strategic plans to meet state contracting and product requirements. Evaluate and refine tactical plans to manage medical costs effectively. Required Qualifications Minimum of 10 years experience with advanced negotiation in large or complex provider environments. Experience in Medicaid provider contracting, including hospitals, physician groups, and ancillary providers. Hands‑on experience with behavioral health network development across inpatient, outpatient, and community settings. Proven end‑to‑end contracting lifecycle management: negotiation, redlining, implementation, and ongoing relationship management. Strong knowledge of Medicaid regulations, state requirements, and network adequacy standards. Experience developing or supporting value‑based arrangements and reimbursement models within Medicaid and behavioral health populations. Ability to build, manage, and grow strategic relationships that support long‑term organizational goals. Strong presentation skills for conveying complex information to diverse audiences. Preferred Qualifications Working knowledge of provider financial issues and competitor strategies. Prior experience leading a team. Bachelor’s degree or equivalent combination of education and experience. Pay Range The typical pay range for this role is $100,000.00 – $231,540.00. Base salary will be determined by experience, education, geography, and other factors. The position may include bonus, commission, short‑term incentive, and equity award opportunities. Benefits Full‑time employees are eligible for a comprehensive benefits package that includes medical, dental, vision coverage, paid time off, retirement savings options, and wellness programs. EEO Statement Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr 4062 Aetna Resources, LLC