Lead Director, Network Compliance & Regulator - Northeast

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 role will be hybrid if the person sits within 25 miles of an office. Position Summary This is a dynamic position on the Network Strategy and Provider Experience team supporting state and regulatory network‑related inquiries, filings, data requests, etc. This individual will be responsible for partnering with and leading engagement across Compliance and Regulatory Affairs to understand specific compliance requirements for their assigned region that impact Network, as well as national mandates such as Mental Health Parity (MHP) that have network implications. This includes understanding all associated network requirements and working with the local network leadership teams to ensure their awareness of requirements, drive alignment, and determine required actions to comply with regulatory mandates. This position will support the production of the network exhibits required for state‑specific filings within their assigned region, which will include coordination and collaboration with teams that own the source data such as Provider Data Services (PDS) and the Network Government Services team. This role will also partner closely with the Commercial Regions Compliance (MCCs) and local network teams across the region for all network filings and state regulatory‑related data requests to help ensure accuracy, completeness, and timeliness of submissions. This role serves as the primary point of accountability for network regulatory readiness and risk management within the assigned region. Fundamental Job Components Responsible for producing and overseeing the completion of network exhibits required for state‑specific network filings and ensuring they meet regulatory specifications Coordinate and lead network responses and preparation for regulator‑identified adequacy gaps, including analysis, justification narratives, alternative access filings (AADRs), and documented recruitment efforts Respond to market conduct exams, CMS audits, DOI exams, accreditation reviews (e.g., NCQA), and ad hoc regulatory inquiries Ensure accurate, timely data submission, narrative responses, and supporting documentation across all required regulatory forums Support and track corrective action plans, appointment wait time remediation, and mitigation strategies as needed Participate in and provide network leadership representation for the network adequacy oversight committee Partner with compliance, legal, and regulatory teams to ensure consistency and accuracy of guidance shared with network leadership teams Serve as the primary network liaison and subject matter advisor for compliance and regulatory initiatives Serve as Network's business area contact (BAC) and primary liaison for the Business Compliance Office (BCO) in support of mandate implementation Foster a culture of regulatory compliance, accountability, transparency, and collaboration across network and partner teams Required Qualifications & Experience 10+ years of experience within the healthcare industry 3–5 years of experience supporting healthcare regulatory and compliance frameworks impacting provider networks Strong program leadership, organizational, and meeting facilitation skills Demonstrated ability to deliver executive‑level communication, reporting, and stakeholder management Experience partnering cross‑functionally with Legal, Compliance, Regulatory, Operations, and provider‑facing teams Proven ability to translate complex requirements into clear, actionable guidance and scalable operational processes Proficient in Microsoft Office Suite (Excel, PowerPoint, Word, Teams) Willingness and ability to travel as needed Preferred Qualifications Working knowledge of provider network structures, data, and supporting systems Ability to interpret and apply regulatory requirements within a healthcare/network environment Strong cross‑functional collaboration skills across diverse stakeholder groups Proven ability to deliver executive‑level communication and influence decision‑making Demonstrated strength in risk identification, mitigation, and problem‑solving Experience driving change management initiatives and operational execution Familiarity with data and analytics platforms such as Alteryx, Dataiku, or similar tools 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. Benefits: Medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources based on eligibility. Equal Opportunity CVS Health is an equal‑opportunity/affirmative action employer, including Disability/Protected Veteran – committed to diversity in the workplace. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr Hispanic Alliance for Career Enhancement