Lead Director, Network Compliance & Regulator - Northeast

Network Strategy And Provider Experience Team Member

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 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
• 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.
• 35 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

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.

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.