Executive Director, Medicaid Provider Relations & Contracting - Northeast

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.

The Executive Director, Medicaid Provider Relations & Contracting for the Northeast Region is responsible for leading provider engagement and contracting strategies across a complex portfolio of Medicaid markets. This leader ensures consistent execution of provider strategies while balancing unique state requirements, market conditions, provider dynamics, and regulatory obligations across multiple Northeast Medicaid programs.

The role serves as a connector between regional strategy and local market execution, partnering with regional leaders, market leaders, Network, Operations, Clinical, Compliance, and Government Programs teams to create consistent provider engagement standards and scalable contracting practices.

Market-Specific Responsibilities

• Lead provider relations and contracting activities across multiple Medicaid markets within the Northeast Region.

• Create consistent provider engagement standards and contracting practices while adapting to state-specific requirements.

• Partner with regional leadership to develop scalable provider strategies that improve execution, operational efficiency, and provider experience.

• Drive best-practice sharing across markets to strengthen provider partnerships and improve network performance.

• Support complex provider negotiations and contracting initiatives that span multiple markets or provider systems.

• Develop regional dashboards and executive reporting that provide visibility into provider satisfaction, network health, and contracting outcomes.

Core Responsibilities

Strategic Leadership

• Lead the development and execution of Medicaid provider engagement and contracting strategies for the assigned market or region.

• Align provider relations and contracting activities with market priorities, growth objectives, regulatory requirements, and business performance goals.

• Serve as a senior Network leader and trusted partner to market, regional, compliance, operations, clinical, and government programs leadership.

Provider Relations

• Build and maintain strong relationships with key provider organizations, health systems, physician groups, ancillary providers, behavioral health partners, and community-based organizations.

• Oversee provider outreach, education, issue resolution, escalation management, and ongoing provider engagement activities.

• Use provider feedback and market insights to identify opportunities to improve provider experience and reduce avoidable friction.

Contracting & Network Management

• Provide executive oversight of Medicaid provider contracting strategy, negotiation support, and network development priorities.

• Ensure network adequacy standards are met and sustained in partnership with market and regulatory teams.

• Support complex provider negotiations and strategic contracting initiatives that balance affordability, access, quality, and partnership objectives.

Regulatory & Compliance Oversight

• Ensure provider relations and contracting activities align with state Medicaid contracts, regulatory requirements, audit standards, and internal policies.

• Partner with Compliance, Legal, and Government Programs teams to address regulatory issues, corrective actions, and risk mitigation needs.

• Maintain readiness for state reviews, audits, reporting requests, and network adequacy validations.

Performance & Operations

• Use data, reporting, and provider performance insights to evaluate network health, provider satisfaction, access, issue trends, and operational effectiveness.

• Develop executive-level reporting, recommendations, and business updates for senior leadership.

• Partner cross-functionally to resolve complex provider issues related to access, claims, operations, reimbursement, and service experience.

People Leadership

• Lead and develop provider-facing and contracting colleagues with clear performance expectations, accountability, coaching, and talent development plans.

• Foster a collaborative, inclusive, and market-focused culture centered on execution, continuous improvement, and provider partnership.

• Support workforce planning, succession planning, and change leadership as Medicaid Provider Relations and Contracting work transitions into local market structures.

Must live in region: Virginia, West Virginia, Maryland, Pennsylvania, New Jersey or New York.

Qualifications

• 10+ years of progressive experience in Medicaid network management, provider relations, provider contracting, managed care, or a related healthcare leadership role.

• 5+ years of leadership experience managing provider-facing, contracting, or network management teams.

• Demonstrated experience working in Medicaid programs and navigating complex state regulatory environments.

• Proven ability to influence senior leaders, manage complex provider relationships, and lead execution in a matrixed organization.

• Strong analytical, communication, negotiation, and relationship-building skills.

• Education: Bachelors degree or equivalent

Preferred Qualifications

• Experience leading provider relations and contracting functions across multiple Medicaid states.

• Strong understanding of multi-state Medicaid operations, regulatory requirements, and market variation.

• Experience managing geographically dispersed teams through change or operating model transformation.

• Demonstrated ability to create common standards while preserving appropriate local market flexibility.

Key Competencies

• Strategic leadership and market-focused decision making

• Medicaid market expertise and regulatory acumen

• Provider relationship management and stakeholder influence

• Contract negotiation and network development

• Business, financial, and operational acumen

• Change leadership and continuous improvement

• Executive communication and data-driven decision making

• Talent development and organizational leadership

Pay Range

The typical pay range for this role is:

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. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.