AVP, Payer Relations Strategy and Execution

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.
** AVP, Payer Relations Strategy and Execution
** The AVP, Payer Relations Strategy and Execution is a senior leadership role accountable for sharping CVS Pharmacy’s payer posture for its largest and most complex payer relationships. This role is responsible for designing forward-looking payer strategy, enforcing pricing discipline, and expanding enterprise partnerships beyond transactional negotiations.

This is a strategy-first leadership role with targeted but critical negotiation ownership. Success requires anticipatory thinking, independent judgment, and the ability to operate credibly with enterprise executives and sophisticated payer counterparts.

Directly responsible for the oversight and administration regarding contract negotiations of rates, terms and conditions with multiple payers (PBMs, clients, third parties) that fall within the annual forecasted financial plan; this includes program parameters, workflow management for many Network programs, such as Performance programs, Medication Adherence, CMRs, and also “umbrella rate” terms such as National Commercial GER/BER and OED and managing through the terms and efforts of quarterly/end-of-year reconciliation efforts by multiple payers/PBMS/Plans.

Develop new methods of troubleshooting reconciliations to arrive at creative solutions that helps improve our overall net effective rates.

Negotiates and understands the strategic development, coordination, and implementation of the operations and forecasting of financials associated with each contract in order to relay and support the review and analysis of the Finance department data and accurate reporting to meet forecasted projections;
Oversight and direction of final contract execution of payer contracts;
Creates quality assurance protocol and methodology enhancements to eliminate missed contractual PBM / client guarantees; plan, anticipate and solve for potential adverse impacts such as financial penalties, to help support and uphold specific payer contractual guarantees, including enterprise financial and clinical efforts. Drive collaboration with Legal, Government Affairs, and Payer Relations Finance teams to interrupt Payer negotiation stalemates through creative development of cost assurances and other calculated risk offerings.

Negotiate for return of monies through unexpected industry wide pricing changes, adverse supply situations and other pivotal events that if not addressed can negatively impact earnings, patients and other constituencies.

Drive new products in the CVS retail pharmacy space (Cost Vantage) and indirectly support new PBM initiatives  to align with the market place and create positive next generation opportunities for overall enterprise financial and strategic value;
Directly support contract negotiation and execution of key specialty initiatives in CVS pharmacy and client plan contract arrangements and operational execution, as applicable and aligned with other enterprise initiatives (e.g., biosimilars, LDD/EDD opportunities)
Oversight of 3-5 direct reports (Executive Directors, Lead Directors) and 3 – 5 indirect reports (Lead Directors, Account Executives, Senior Managers) who will be responsible for the management and growth of our payer partners, with the primary focus to lead and develop the team to set, drive and align organizational focus and strategy with their assigned payers, and develop internal succession planning for long-term success in negotiating contracts on behalf of CVS Retail, LTC, Clinic, Immunization, and Specialty channels;
Create different opportunities within the Payer Value Proposition to troubleshoot financials and continue the relationship to reset through pricing  strategies that are new and unique in…