[Hiring] Senior Network Contracting Negotiation Manager @CVS Health

Role Description

In this individual contributor role, the Network Management Senior Manager will:

• Negotiate, execute, and conduct high-level review and rate analysis, dispute resolution, and/or settlement negotiations of contracts with larger and more complex, regional-based hospital systems, large physician groups, and ancillaries in accordance with company standards.
• Manage contract performance and support the development and implementation of strategic, value-based contract relationships.
• Maintain and enhance provider networks to meet accessibility, quality, financial goals, and cost initiatives for our Medicaid products.
• Recruit providers as needed to ensure attainment of network expansion and adequacy targets.
• Identify and manage cost issues and initiate appropriate cost-saving initiatives and/or settlement activities.
• Represent the company with high visibility constituents, including customers and community groups, promoting collaboration with internal partners.
• Optimize interaction with assigned providers and internal business partners to facilitate relationships and ensure provider needs are met.
• Participate in JOC meetings.
• Manage complex contractual relationships with providers according to prescribed guidelines in support of national and regional network strategies.
• Collaborate cross-functionally to manage Hospital, Ancillary, and provider compensation and pricing development activities, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities.
• Serve as SME for less experienced team members and internal partners.
• Provide network development, maintenance, and refinement activities and strategies in support of cross-market network management unit.
• Assist with the design, development, management, and/or implementation of strategic network configurations and integration activities.
• Ensure resolution of escalated issues related to claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.

Qualifications

• 7+ years healthcare industry experience.
• 5+ years related experience and comprehensive level of provider negotiating skills with a successful track record negotiating contracts with complex provider systems or groups.
• Must reside in Michigan.
• Critical thinking to maintain cost management and a fully engaged network of participating hospitals, ancillaries, and providers.
• Microsoft Office/Excel proficient.
• Ability to travel in assigned market up to 10-15% of the time as needed (Michigan).

Requirements

• Healthcare Industry experience with either a payer or provider.
• Strong communication, critical thinking, problem resolution, and interpersonal skills.
• Understanding knowledge of Value Based Contracting.
• Internal Aetna system knowledge a plus.
• Understanding of Medicaid.
• Proven working knowledge of provider financial issues and competitor strategies, complex contracting options, financial/contracting arrangements, and regulatory requirements.

Education

• Bachelor’s Degree or equivalent professional work experience.

Pay Range

The typical pay range for this role is:

• $75,400.00 - $165,954.00

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

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