Network Management Jobs in Tulsa, OK (NOW HIRING)

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Position Summary

• The Lead Director will manage the development of contracts and agreements with providers and delivery systems in conjunction with being accountable for designing conceptual models, initiative planning, and negotiating high value/risk contracts with the most complex and challenging, market/region/national, largest group/system or highest value/volume of spend providers 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.

• Negotiates and executes, conducts high level review and analysis, dispute resolution and/or settlement negotiations of contracts with larger and more complex, market-based, group/system providers.

• Manages contract performance and supports the development and implementation of value-based contract relationships in support of business strategies.

• Recruits 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 analysis of reports as part of negotiation and reimbursement modeling activities.

• Responsible for identifying and managing cost issues and initiating appropriate cost saving initiatives and/or settlement activities. Assists with the design, development, management, and or implementation of strategic network configurations and integration activities.

• Drives or guides development of holistic solutions or strategic plans negotiates and executes contracts with the most complex, market /region/national, largest group/system or highest value/volume of spend providers with significant financial implications.

• Recruits 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.

• May optimize interaction with assigned providers and internal business partners to facilitate relationships and ensure provider needs are met.

• Ensures resolution of escalated issues related to contract interpretation and parameters.

• Interprets contractual requirements including federal and state regulations and NCQA.

• Participates in JOC meetings.

• Promotes and educate providers on cultural competency.

• Sets specific, challenging and achievable objectives and action plans.

• Manages complex, contractual relationships with providers according to prescribed guidelines in support of national and regional network strategies.

• Mentor and coach new/more junior staff to educate and inform on accreditation and regulatory standards as well as policies on credentialing and re-credentialing.

Required Qualifications

• 10+ years of related healthcare contracting experience, including expert-level negotiation skills and a proven track record of successfully negotiating contracts with large, complex national providers and vendor organizations.

• 2+ years of people leadership experience, with demonstrated ability to lead, develop, and influence high-performing teams.

• Strong knowledge of provider financial management, competitive market strategies, complex contracting methodologies, value-based and risk-based arrangements, and applicable regulatory requirements.

• Demonstrated success identifying and leading initiatives that improve total cost of care, enhance quality outcomes, and drive organizational performance.

• Extensive experience within a health plan, payer, or provider system environment, with a deep understanding of healthcare delivery and reimbursement models.

Preferred Qualifications

Education:

• Bachelor's Degree required or a combination of professional work experience and education.

Pay Range

The typical pay range for this role is:

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.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.