Lead Director, Provider Performance Value-Based Care

Role Description

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 Keystone Value-based Network as outlined below:

• Accountable for building strategic relationships with 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 complex arrangement structures, which requires:
  • Understanding providers’ volume and cost structure.
  • Working cross-functionally to identify levers and critical negotiation points.
  • Aligning negotiation strategies and tactics with network accessibility, quality, compliance, and financial performance goals.
• In charge of the 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 objectives for value-based provider agreements are met.
• Evaluates, helps formulate, and implements network strategic plans to achieve value-based contracting targets and manage medical costs through effective value-based contracting.
• Provides assistance and support to other departments, as needed, to obtain crucial or required information from providers, such as HEDIS, Credentialing, Grievance and Appeals, SIU, etc. Coordinates provider status information with member services and other internal departments.
• 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.

Qualifications

• 10 years of related experience and comprehensive level of negotiating skills with a successful track record negotiating value-based contracts with IPAs, large complex provider systems or groups, hospitals, and large physician entities.
• Experience reviewing medical claims data and developing executive summaries and identifying opportunities for mitigating medical cost trends.
• 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 with various interested parties.

Requirements

• 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 Medicaid 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.

Benefits

• Comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families.
• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources, based on eligibility.