Lead Director, Network Management (Kentucky)

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. Position Summary The Kentucky Network Lead Director will be accountable for developing strategic partnerships for the Kentucky Medicaid Health Plan. Strong focus on designing conceptual models, initiative planning, and negotiating high value contracts with the most complex and challenging hospital systems, integrated delivery systems and large groups in accordance with company standards in order to maintain and enhance provider networks, while working cross functionally to ensure consistency with all contracting strategies and meeting and exceeding accessibility, quality, compliance, and financial goals and cost initiatives. Contracting responsibilities include Medicaid. Key Responsibilities Key focus on building strong relationships with providers as well as developing and executing contract strategies and yield market leading discount and cost positions for Aetna as well as value-based relationships that improve the quality and financial performance of Aetna's networks for its members. Responsibilities include negotiation and management of various value based payment models and management of contract performance associated with these models with key focus on provider engagement. Recruit providers as needed to ensure attainment of network expansion and adequacy targets. Accountable for cost arrangements within defined groups. Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities. Responsible for identifying and managing cost issues and collaborating cross functionally to execute significant cost saving initiatives. Represents company with high visibility constituents, including customers and community groups. Promotes collaboration with internal partners. Evaluates, helps formulate, and implements the provider network strategic plans to achieve contracting targets and manage medical costs through effective provider contracting to meet state contract and product requirements. Collaborates with internal partners to assess effectiveness of tactical plan in managing costs. Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information. Helps mentor and develop others within the department by providing shadowing opportunities and acting as a subject matter expert. Required Qualifications A minimum of 10 years related experience and expert level negotiation skills with successful track record negotiating contracts with large or complex provider systems. Demonstrated experience in Medicaid provider contracting, including negotiating, executing, and managing agreements with hospitals, physician groups, and ancillary providers Hands-on experience with Behavioral Health (BH) network development and contracting, including providers across inpatient, outpatient, and community-based settings Proven ability to manage the end-to-end contracting lifecycle (negotiation, redlining, implementation, and ongoing relationship management) Strong knowledge of Medicaid regulations, state requirements, and network adequacy standards, with the ability to ensure compliance across market Experience developing or supporting value-based arrangements and reimbursement models within Medicaid and Behavioral Health populations Demonstrated ability to build, manage, and grow strategic relationships that advance long-term organizational goals. Experience presenting complex information to groups in a clear, concise, and persuasive manner, adapting style and content to audience needs. Preferred Qualifications Proven working knowledge of provider financial issues and competitor strategies. Previous experience with leading a team. Education Bachelor's Degree preferred or equivalent combination of education and experience 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. Benefits 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: 06/27/2026 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