Lead Director, Provider Engagement, CVS Health

CVS Health

Location:
United States, Austin

Category:
Health and Beauty

Contract Type:
Employment contract

Salary:

100000.00 - 231540.00 USD / Year

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Job Description:

The Lead Director, Provider Engagement at CVS Health manages compliance with Provider Engagement responsibilities and oversees internal and external provider relationships while driving network performance and supporting growth initiatives.

Job Responsibility:

Responsible for updating and monitoring performance of KPI/Goals
Manages Local Provider Engagement Team to Deploy National Engagement Model
Responsible for maintaining local policies and procedures
Manages Local Provider Relations staff to ensure Market Leading Provider Satisfaction
Collaborate with the Operations Department for claims triage, escalations where applicable, and Provider education
Facilitate and/or Chair Provider Advisory Group and JOC meetings
Oversees the monitoring of State and Federal requirements, reporting, and audits
Provides oversight for Provider Escalations at the Health Plan and State level
Oversees staff responsible for initial and ongoing provider education
Responsible for required Provider Satisfaction end-to-end process and Stakeholder partnership to ensure alignment with Market established SOW
Compiles data and staff metrics to complete regulatory deliverables
participates in all internal compliance audits and Regulatory reviews
Ensures accurate and ongoing reconciliation of provider records to maintain data integrity
Oversees provider Access and Availability by reviewing audits conducted by third party vendor and/or staff
and monitoring performance trends
Ensures all related documentation is accurately recorded and maintained in the designated repository for compliance and audit readiness
Oversight of Provider website, directories, manuals, and dashboards
Plans, coordinates, and conducts provider forums and monthly webinars
Develops communications including newsletters, notifications and email/fax blasts in collaboration with Provider Enablement & Strategy
Collaborate with Provider Enablement & Strategy on Provider-facing communications, desktops, workflows, external trainings, reporting, and HUB support
Recruits, develops, and supports staff
Manages key personnel actions such as hiring, terminations, performance, salary reviews, and disciplinary actions
Tracks performance through weekly metrics, holds regular one-on-one meetings, and provides coaching and mentoring as needed
Incorporate and demonstrate Heart at Work Behaviors on a consistent basis
Promotes and educates providers on Cultural Competency and Critical Incidents

Requirements:

Minimum of 5 to 7 years of recent Managed Care experience in Network/ Provider Engagement
Employee Supervision with 3-5 Years in Medicaid Network/Provider Engagement
Travel within the state as needed
Excellent interpersonal skills and the ability to work with others at all levels
Candidate must reside in Texas

Nice to have:

Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claims Lifecycle, Provider Appeals & Disputes, and Network Performance Standards
Experience in Medical Terminology, CPT, ICD-10 codes, etc.
Excellent analytical and problem-solving skills
Strong communication, negotiation, and presentation skills

What we offer:

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 including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, and retiree medical access

Additional Information:

Job Posted:
October 16, 2025

Expiration:
October 31, 2025

Employment Type:

Fulltime

Work Type:

On-site work

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Lead Director, Provider Engagement