VBC Lead Director, Network Management (NJ and NY)

Job DescriptionThe VBC Lead Director, Network Management is responsible for leading the value-based care strategy for the NY l NJ market. The right candidate will possess a strong understanding of the shift towards Value Based Care and the requirements needed to be successful in Medicare and Commercial alternative payment arrangements. The VBC Lead Director, Network Management is a key role on the NY/NJ Network Management team reporting to the Chief Network Officer. To be successful in this role, you will have extensive experience in sourcing, structuring, negotiating complex Value Based Care agreements and managing partnerships to maximize value creation. You possess deep knowledge of the healthcare industry, partnership structures, value-based arrangements and risk-based payment models. You have a cross functional perspective and can effectively engage internal and external teams to achieve desired outcomes. You are action oriented, and outcomes driven. You are proactive and creative in leveraging your extensive knowledge of the healthcare industry and partnership types to identify and execute VBC partnerships. You have experience in deal development and execution. You have executive presence and can build strong, collaborative relationships at senior levels within CVS and the partner organization.KEY RESPONSIBILITIES: Responsible and accountable for all VBC contracting within the NY/NJ market Partner with Medical Economics team to assess effectiveness of tactical and strategic plans in managing VBC performance Promotes collaboration with internal partners and works closely with the Chief Medicare Officer, VBC engagement managers, network, sales and product teams Designs, develops, implements, and manages network contracts with VBC providers while adhering to pre-determined internal guidelines and financial standards and targets. Demonstrated ability to establish effective value-based partnerships with providers, which may require new and innovative approaches that rely upon the candidate's deep expertise of the NY/NJ market, its regulatory environment, and providers' desired value-based measures and outcomes. Accountable for VBC medical cost management for the market and responsible for understanding and managing medical cost issues and initiating appropriate action. Identifying new provider partners to enter new VBC or VBC product arrangements that will generate membership growth across business lines Build and maintain a strong external intelligence on the VBC ecosystem and trends to continuously inform provider strategyPay RangeThe typical pay range for this role is:Minimum: 100,000Maximum: 221,000Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required Qualifications5-10 years related experience in health operations, network relations and development, command of financials and pricing strategies, and sales interface. In-depth knowledge of various reimbursement structures and payment methodologies for both hospitals and providers. Knowledge and experience with value-based contracting and accountable care models: episodes, bundles, PCMH, gainshare, riskIn-depth knowledge of managed care business, regulatory /legal requirements.Ability to travel to New York and New JerseyCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred QualificationsPayor AND Provider experience preferredMedicare risk model experienceSolid leadership skills, including staff development and talent management.Preferred locations: New York and New JerseyEducationBachelor's degree or equivalent work experience MBA/Master's degree preferredBusiness OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2025-01-11