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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.
Position Summary:
The Lead Director will be part of the Aetna Network organization and have oversight and monitoring of Medicaid network compliance requirements, focused first on Medicaid credentialing and provider data tasks. The role will collaborate cross-functionally with Compliance, Legal, local Medicaid Health Plans, Medicaid Network Contracting and Medicaid Provider Relations, and other departments to maintain compliance of provider related tasks. The Lead Director may manage a small team and expand accountability to broader Network compliance needs over time.
Responsibilities:
- Medicaid network compliance of Medicaid credentialing and provider data tasks.
- Collaborate with Legal and Compliance to ensure alignment on and understanding of business interpretation of Compliance requirements.
- Ensure Medicaid Provider Operations and Support and network policies and procedures are executed in alignment with business interpretation of compliance requirements and consistently across business operations.
- Lead department and cross-functional initiatives to support Compliance requirements.
- Cultivate and manage relationships with various internal teams.
Required Qualifications:
- 5+ years of related health care payer experience
- 5+ years of provider operations experience
- 5+ years of compliance related engagement
- 2+ years of provider data and provider contracting activities/support
- Understand provider contracts, contracting options, and operational issues related to provider data, contracting, and relations.
- Experience interpreting and supporting state Medicaid contracts and requirements.
Preferred Qualifications:
- Provider Credentialing experience.
- Experience with NCQA requirements.
- Medicaid provider data, provider relations, or provider contracting experience.
- Project management and delivery experience in highly matrixed organizations.
- Working knowledge of quick base, excel, Prodata, Quest, and other tools for working with provider data.
- Proven ability to work collaboratively at all levels and affect change.
- Exercise sound judgment and demonstrates analytical/data-driven decision-making skills.
Education:
Bachelor’s degree or equivalent professional work experience.
Pay Range:
The typical pay range for this role is: $100,000.00 - $231,500.00. 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.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long-term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time, and other time off are provided consistent with relevant state law and Company policies.
We anticipate the application window for this opening will close on: 05/17/2024.
CVS 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.
CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through . If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.
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