Lead Director, Network and Trend Optimization - West Region Remote

Lead Director, Regional Network And Trend Optimization

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 Overview

Reports To : Executive Director, Region Development Officer

Manages medical cost by partnering with Provider Contracting, MEU, Pharmacy, Claims Cost Management, Innovation, and Clinical to ensure aggressive management of medical cost trends to achieve the best price for our products and services.

Connects internal and external relationships within the Commercial segment, across all Aetna shared services, to drive commercial medical development activities and frameworks to integrate business strategies across the Enterprise.

Job Summary

The Lead Director, Regional Network and Trend Optimization serves as a pivotal liaison between Network, Finance, Clinical Operations, and Sales Teams. This role is responsible for identifying and implementing opportunities to enhance cost efficiency and quality performance within the region. The incumbent will collaborate closely with the Network's data and analytics teams to analyze healthcare cost trends and leverage resources effectively to maximize results. This role is responsible for collaborating with Network teams ensuring competitive provider networks, proactively monitoring healthcare cost and utilization trends. Additionally, this role will work with sales teams in top-tier priority markets to develop strategies that improve our network's cost position and engage with commercial stakeholders.

Key Responsibilities

Strategic Collaboration

Act as the primary point of contact for the West Region between network, medical economics, clinical operations, finance team, and sales teams to align financial strategies with clinical objectives and market needs.

Develop and execute strategic initiatives through pricing, network curation, and medical management that lead to sustainable long-term growth and revenue.

Market Network Strategies

Develop and implement strategies to align with network contracting priorities with commercial trend management goals.

Ensure the organization maintains competitive network arrangements to support cost-effective and high-quality care delivery.

Medical Cost and Trend Management

Identify and execute meaningful initiatives to mitigate trends and provide competitive products.

Track and analyze industry trends and healthcare utilization benchmarks.

Sales Collaboration

Partner with sales teams in top-tier priority markets to develop strategies that improve our network's cost position and support commercial objectives.

Key Stakeholder Engagement

Participate in high-level meetings with network leadership and commercial stakeholders to present findings, propose initiatives, and drive decision-making processes.

Act as a subject matter expert in network performance and trends for the Region.

Performance Reporting and Monitoring

Establish and oversee key performance indicators (KPIs) to track the success of implemented strategies and ensure continuous improvement.

Required Qualifications

Minimum of 7-10 years in healthcare industry experience, network management, contracting, actuarial, underwriting, finance, clinical operations, trend analytics, and / or related field.

At least 5 years in a role involving cross-functional collaboration.

Strong understanding of healthcare systems, reimbursement models, healthcare cost trends, network contracting principles, and provider relations.

Proven ability to analyze and interpret complex data sets to develop actionable strategies.

Skills

Strong communication skills, including experience presenting to senior leadership.

Strong analytical abilities with proficiency in data interpretation and financial modeling.

Proven track record of implementing cost-saving initiatives without compromising quality of care.

Ability to influence and drive change within a complex organizational structure.

Preferred Qualifications

Experience working with sales teams and commercial stakeholders.

Experience with healthcare data analytics platforms and electronic health record (EHR) systems.

Knowledge of regional healthcare regulations and reimbursement models.

Certification in healthcare finance or management (e.g., HFMA, ACHE).

Education

Bachelor's degree preferred in healthcare administration, Finance, Business or a related field / specialized training / relevant professional qualification.

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 our comprehensive and competitive mix of pay and benefits investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include :

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.

We anticipate the application window for this opening will close on : 11 / 06 / 2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer. 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.