[Hiring] Senior Network Provider Manager @CVS Health

Role Description

The Medicaid Senior Manager, Network Management:

• Negotiates, executes, conducts high level review and analysis of dispute resolution and/or settlement negotiations of contracts with national providers including, but not limited to labs, Home Health, Home Infusion, Dialysis Centers, Transportation and Vision vendors, in accordance with company standards to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals and cost initiatives.
• Recruit providers as needed to ensure attainment of network expansion goals, achieve regulatory and/or internal adequacy targets.
• Support health plan with expansion initiatives or other contracting activities as needed.
• Initiates, coordinates and owns the contracting activities to fulfillment including receipt and processing of contracts and documentation and pre- and post-signature review of contracts and language modification according to Aetna’s established policies.
• Responsible for auditing, building, and loading contracts, agreements, amendments and/or fee schedules in contract management systems per Aetna’s established policies.
• Conducts research, analysis and/or audits to identify issues and propose solutions to protect data, contract integrity and performance.
• Manages contract performance and supports the development and implementation of value-based contract relationships in support of business strategies.
• Collaborates cross-functionally to manage 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.
• Provides Subject Matter Expert support for questions related to recruitment initiatives, contracting, provider issues/resolutions, related systems and information contained.
• Provides guidance and shares expertise to others on the team.
• Understanding of Value Based contracting and negotiations.
• Manages high level projects and recruitment initiatives with interdepartmental resources and/or cross functional stakeholders.
• May participate in JOC meetings.
• Supports or assists with operational activities that may include, but are not limited to, database management and contract coordination.
• Organizes and transforms information into comprehensible structures.
• Uses data to predict trends in the customer base and the consumer population as a whole.
• Performs statistical analysis of data.
• Uses tools and techniques to visualize data in easy-to-understand formats, such as diagrams and graphs.
• Prepares reports and presents these to leadership.
• Engages with providers and quickly moves the providers through contracting processes in order to ensure meeting network adequacy requirements.

Qualifications

• 5+ years of network contracting/management experience.
• Ability to travel as needed (up to 25% travel).
• 5 years of proven knowledge of standard provider contracts, terms and language.
• 5 years of solid negotiating and decision-making skills while executing national, regional, or market level strategies.
• In-depth knowledge of the managed care industry and practices, as well as a strong understanding of competitor strategies, practices, and financial/contracting arrangements.
• Knowledge of ancillary contracting, i.e. DME, Lab, Infusion, Home Health, Urgent Care and Vendor.
• Demonstrated high proficiency with personal computer, mouse, keyboard and all MS Office suite applications (e.g., Outlook, Word, Excel, etc.).
• Knowledge of Medicaid programs.
• Solid decision-making skills while executing national, regional, and market level strategies.
• Ability to forge long-lasting relationships.
• Possess critical thinking, problem resolution and interpersonal skills.
• Ability to identify and capitalize on opportunities to support program delivery.
• Strong communication skills (written, verbal and presentation).
• Highly organized and self-driven.

Preferred Qualifications

• Knowledge of Medicare and commercial programs and related subject matter.

Education

• Bachelor's degree or equivalent professional work experience.

Pay Range

The typical pay range for this role is: $67,900.00 - $149,328.00. 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

• Comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families.
• Benefits include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Company Description

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.