Executive Director, Provider Relations & Contracting - Medicaid - Southeast

Job description

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 Southeast is responsible for leading Medicaid provider engagement, network contracting, and provider performance strategies across a large and dynamic Medicaid region. This leader drives network growth, provider satisfaction, access strategies, and regulatory compliance while strengthening relationships with major health systems, physician organizations, community providers, and state stakeholders. The role partners closely with Market Presidents, Network Leaders, Medicaid business leadership, Operations, Clinical, Compliance, and Government Programs teams to ensure provider networks support market growth, quality outcomes, member access, and competitive performance. Market-Specific Responsibilities • Lead provider relations and contracting strategy across the Southeast Medicaid region. • Develop provider engagement plans that address market growth, network expansion, and competitive provider dynamics. • Establish executive-level relationships with major health systems, physician organizations, FQHCs, behavioral health providers, ancillary providers, and community-based organizations. • Identify opportunities to expand access in rural, underserved, and high-growth communities. • Support strategic provider negotiations that strengthen network adequacy, affordability, and long-term provider partnerships. • Drive initiatives focused on provider satisfaction, value-based relationships, and provider service experience improvement. 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 Southeast region. 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. • Bachelors degree or equivalent Preferred Qualifications • Experience leading Medicaid provider relations or contracting in large-scale, multi-state markets. • Experience managing complex provider systems and competitive provider environments. • Knowledge of Southeast Medicaid programs and provider ecosystems. • Experience supporting network growth, access expansion, and provider experience improvement initiatives. 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