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.
Position Summary
The Lead Director will be accountable for developing strategic partnerships to ensure Aetna has market leading discount and cost positions and high value, competitive networks. Strong focus on designing conceptual models, initiative planning, and negotiating high value contracts with the most complex and challenging hospital systems, integrated delivery systems and large groups 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. Contracting responsibilities include Medicare and Commercial.
Leads Provider Relations Operations & Network Strategy: Oversees teams responsible for building and managing relationships with existing and new providers across assigned geographies. Directs network development for Commercial and Medicare products, including contracting, retention, provider servicing, and ensuring compliance with policies and standards.
Drives Cross‑Functional Collaboration & Operational Excellence: Partners with internal departments to implement complex provider contracts, support reimbursement methodologies, resolve billing issues, and address medical cost drivers. Serves as the primary liaison for regulatory audits, credentialing requirements, grievance and appeals monitoring, and ensures timely, compliant issue resolution.
Manages Provider Education, Communication & Engagement: Develops and executes provider communication strategies including newsletters, notifications, forums, and orientations. Ensures consistent delivery of education on new protocols, policies, and contract requirements. Oversees maintenance of provider resources such as portals, directories, and manuals; represents Provider Relations in community, sales, and marketing initiatives.
Key focus on building strong relationships with providers as well as developing and executing contract strategies and yield market leading discount and cost positions for Aetna as well as value-based relationships that improve the quality and financial performance of Aetna's networks for its members. Responsibilities include negotiation and management of various value based payment models and management of contract performance associated with these models with key focus on provider engagement.
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.
Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.
Guides management for individual performance evaluations aimed to provide critical feedback for skills development and depth of work area experience.
Required Qualifications
A minimum of 10 years of progressively responsible experience in provider relations, contracting, or healthcare operations, demonstrating expertise in managing provider networks, negotiating agreements, improving operational processes, and fostering collaborative relationships with internal and external stakeholders.
A minimum of 3 years of people management experience, demonstrating the ability to lead, coach, and develop teams; manage performance; foster engagement; and drive operational excellence through effective leadership practices.
Demonstrated knowledge of value-based contracting structures, including negotiation and implementation of agreements that align cost, quality, and performance outcomes across stakeholders.
Experience with Medicare, Commercial contracting and various reimbursement methodologies.
Demonstrated ability to build, manage, and grow strategic relationships that advance long-term organizational goals.
Experience presenting complex information to groups in a clear, concise, and persuasive manner, adapting style and content to audience needs.
Preferred Qualifications
Proven working knowledge of provider financial issues and competitor strategies.
Education
Bachelor’s Degree preferred or equivalent combination of education and experience
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.
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on: 04/18/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.