[Hiring] Network Development and Contracting Medicaid @CVS Health

Role Description

The Medicaid VBS Network State Manager manages and oversees compliance with our Network responsibilities as provided within the State Medicaid contractual requirements.

• Accountable for working with strategic provider partners to promote innovative value-based solutions to meet total cost and quality goals for Medicaid businesses.
• Responsible for deploying alternative payment models, executing new initiatives, and negotiating value-based contracts, which requires:
  • Basic understanding of the providers’ volume and cost structure.
  • Conducting negotiation following PADU tool.
  • Aligning negotiation tactics with goals encompassing network accessibility, quality, compliance, and financial performance.
• Works with Practice Transformation Team, VBS reporting team, and other key internal teams to develop a value-based strategic plan and manage contract performance with targeted provider groups to ensure compliance with state guidelines.
• In charge of complete value-based contracting cycle from planning, creating documents, and negotiation to overseeing loading of executed arrangements, including:
  • Recruiting providers to ensure attainment of network expansion and adequacy targets.
  • Negotiating payment arrangements with providers and operational ability of established contracts.
  • Overseeing the monitoring and loading of executed value-based provider contracts to ensure State requirements.
  • Evaluating, formulating, and implementing provider network strategic plans to achieve value-based contracting targets.
• Manages combined functions for external provider engagement representatives and internal provider relations representatives to ensure successful Provider Relationships and Network Performance, including:
  • Representing the company with high visibility constituents, including customers and community groups.
  • Promoting collaboration with internal partners.
  • Continuous review of value-based provider performance and movement along the value-based continuum.
  • Recommending training programs and educational materials for providers and internal staff.
  • Collaborating with internal partners to assess effectiveness of tactical plans in managing costs.
  • Facilitating and attending provider meetings and negotiations, including travel as needed.
  • Coordinating provider information with member services and other internal departments.
  • Providing assistance and support to other departments to obtain crucial information from Providers.

Qualifications

• Minimum of 7 years recent Managed Care Network Value Based Contracting experience with 2-3 years Medicaid Network experience.
• Must have Microsoft Office experience with intermediate to advanced Excel and PowerPoint skills.
• Excellent interpersonal skills and the ability to work with others at all levels.
• Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes, and Network Performance Standards.
• Excellent analytical and problem-solving skills.
• Strong communication, negotiation, and presentation skills.
• Proven ability to work in a matrixed organization.
• Candidates are to reside within applicable State.
• This is a work-at-home position, with the ability to travel within the state to visit providers or to main office in Aetna Office Locations applicable to the Market.

Preferred Qualifications

• Familiar with legal terms in the context of provider contracting.
• Able to apply system thinking when managing multiple provider value-based initiatives.
• Strong financial modeling background.

Education

• Bachelor’s degree or equivalent professional working experience.

Pay Range

The typical pay range for this role is $75,400.00 - $182,549.00. 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.

Benefits

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include:

• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs.
• Other resources, based on eligibility.

Additional details about available benefits are provided during the application process.