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Lead Director, Network Performance



Woonsocket, RI, USA
Posted on Tuesday, June 11, 2024

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

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 of Network Performance is responsible for the overall Payer connectivity strategy, monitoring, compliance, and resolution process for the Retail organization. You will be accountable for ongoing knowledge of industry and regulatory requirements, policy development, systemic improvements, data insights, vendor partnerships and operational compliance.

In this role, you will be responsible for establishing and ensuring that HIPAA mandated governing pharmacy transaction sets are consistently executed within the Retail organization and are in accordance with company policies and procedures as well as requirements set forth by State and Federal agencies. This role will require working collaboratively and cross-functionally with internal departments, Third-Party Payers, external agencies, and vendors to monitor legislation and regulation impact on claims processing standards, along with relevant impact within the health information technology arena.

Your key job responsibilities will be:

  • Ensure standards are executed across the organization and provide support on adjudication related matters
  • Assist in the development and maintenance of policies and procedures that ensure Retail organization compliance with all Company, Third-Party Payer, State and Federal policies and procedures related to claims processing
  • Work collaboratively with internal and external partners to develop and improve solutions that will enable operational compliance, improve patient care, and drive incremental sources of value
  • Direct a team of professionals that are engaged across the enterprise in order to achieve operational objectives and financial integrity
  • Serve as the main contact for claims processing related issues. Work closely with senior leaders in Retail Operations, Field Leaders, Legal, industry setting organizations, Third-Party Payers, vendors and State and Federal agencies

Required Qualifications

  • 8+ years of experience in Retail Pharmacy business
  • 5+ years of experience in delivering financial results through cross-functional collaboration
  • 5+ years of direct experience creating multi-year strategic business plans
  • 5+ years of experience managing external vendor relationships
  • 5+ years of experience communicating with and influencing Senior Executives
  • Ability to travel up-to-10% of the time

Preferred Qualifications

  • Graduate degree (MBA, Pharm.D., etc.)
  • Highly developed relationship building skills to cultivate effective working relations within the department, across Pharmacy services and functional leaders within the enterprise
  • Experience crafting and leading teams to execute multi-year strategic roadmap that drives incremental value
  • Commitment to results; is an analytical thinker who is customer focused and goal driven. Identifies relevant information and transforms this information into business intelligence
  • 5+ years of deep knowledge of the Retail Pharmacy business and ability to navigate the CSC and Field environment
  • Outstanding written and oral communication skills and the ability to connect with partners across all levels of the organization


Bachelor's degree

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.

For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 06/28/2024