Lead Director, Provider Performance, Value-Based Care

CVS Health

. Establish and maintain productive value-based relationships with key network providers .

Posted 10/15/2026full-timeRemote • United StatesSenior💰 $100,000 - $231,540 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in value-based contracting, including negotiation, strategic planning, and performance management. Proficient in analyzing medical claims data and developing innovative solutions to optimize cost and quality in healthcare networks.

Highest-signal resume keywords

Value-Based ContractingNegotiation SkillsAnalytical SkillsFinancial ModelingHEDIS Familiarity

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Value-Based ContractingNegotiationMedical Claims Data ReviewFinancial ModelingAlternative Payment ModelsContract ManagementStrategic PlanningCost Structure AnalysisExecutive Summaries DevelopmentCompliance Knowledge

Soft Skills

Communication SkillsProblem-Solving SkillsPresentation SkillsConsensus BuildingCross-Functional Collaboration

Industry Keywords

CMS StarsHEDISMedicare ContractingMedicaid ContractingProvider ContractingValue-Based SolutionsNetwork ManagementProvider RelationshipsRisk ContractsHealthcare Cost Management

About the role

Key responsibilities & impact

Establish and maintain productive value-based relationships with key network providers
Develop and manage the Keystone Value-based Network
Build strategic provider-partner relationships and develop innovative value-based solutions to meet total cost and quality goals
Develop alternative payment models and identify and plan new initiatives
Negotiate high-value/risk contracts with complex arrangement structures
Understand providers’ volume and cost structures
Work cross-functionally to identify negotiation levers and critical negotiation points
Align negotiation strategies and tactics with network accessibility, quality, compliance, and financial performance goals
Manage the complete value-based contracting cycle, including planning, document creation, negotiation, and loading executed arrangements
Work with Performance, Clinical Transformation, VBS Analytics, and other internal teams to develop strategic plans and oversee contract performance
Evaluate, formulate, and implement network strategic plans to achieve value-based contracting targets and manage medical costs
Support other departments in obtaining required provider information, including HEDIS, Credentialing, Grievance and Appeals, and SIU information
Coordinate provider status information with member services and other internal departments
Lead complex projects and programs from assessment through implementation across processes, systems, functions, and products
Facilitate and attend external provider meetings and negotiations as needed

Requirements

What you’ll need

10 years of related experience
Comprehensive negotiating skills with a successful track record negotiating value-based contracts with IPAs, large complex provider systems or groups, hospitals and large physician entities
Experience reviewing medical claims data
Experience developing executive summaries and identifying opportunities to mitigate medical cost trends
Excellent analytical and problem-solving skills
Strong communication, negotiation, and presentation skills
Ability to work in a matrixed organization, gain consensus, and share information with various interested parties
Familiarity with legal terms in the context of provider contracting preferred
Familiarity with CMS Stars and HEDIS technical specifications and measurable percentiles associated with HEDIS measures preferred
Experience with Commercial, Medicare and Medicaid contracting preferred
Ability to apply systems thinking when managing multiple provider value-based initiatives preferred
Strong financial modeling background preferred
Bachelor’s degree preferred or a combination of professional work experience and education

Benefits

Comp & perks

Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being
CVS Health bonus, commission or short-term incentive program
Equity award program