Lead Director, Provider Performance-Georgia and...

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position SummaryThis position will support primarily Georgia and the Gulf States markets, given the current VBC footprint and overall complexity of operations in these areas. Role will support VBC contracting efforts, stronger payer-provider relationships and improved financial performance.This position is accountable for the strategic alignment, operational success, and performance management of assigned provider relationships with the most complex/high value initiatives and/or highest risk and revenue generating provider systems, network and value-based relationships. Ensures that assigned value-based contract arrangements are functioning successfully and working to improve quality of care while reducing costs.

• The position is remote and can be in any US location, preference will be given to candidates that reside in Georgia.

• Provider Relationship Management - Understands the terms of the value-based contract arrangements to answer questions/address issues. Responsible for establishing and maintaining productive, professional relationships.
• Educates internal and external parties as needed to ensure compliance with contract terms and expectations.
• Coordinates and prepares for external provider meetings and ensures that the most impactful internal subject matter experts (clinical, pharmacy, financial, analytical, etc.) are utilized to optimize performance. (External meetings include JOCs, clinical meetings, Informatics discussions, contract reconciliations, etc.)
• Assists with workflow development and strategies to integrate data and reporting.
• Works independently to manage relationships and identify/implement solutions to problems.
• Drives provider performance and partners with local market to ensure pathways to performance against business and team objectives.
• Drives improvement in deal performance for multiple lines of business, complex models, and/or advanced national provider partners.
• Leverages reporting/data to monitor contract performance against financial, clinical, cost and efficiency targets. Adept at identifying issues or trends in reporting.
• Identifies improvement opportunities. Provides strategy consultation on actions/tactics to make needed improvements.

• Minimum 10+ years of experience in network relations, VBC arrangements, and performance management in a health plan, health system or provider organization, ACO / managed-care experience preferred
• Proven expertise in contract language and interpretation, financial modeling, and/or risk-based arrangements.
• Strong analytical skills with the ability to assess provider performance and financial impact.
• Self-directed individual with independent problem-solving skills
• Proven ability to interact with, influence and collaborate with internal and external stakeholders at all levels
• Experience managing matrixed environment with ability to leverage internal business partners to complete tasks
• Good interpersonal and communication skills
• Knowledge of healthcare and insurance industry
• Ability to form strong client relationships

• Bachelor’s degree preferred in business administration, HealthCare Administration, or a related field or equivalent work experience.

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.