Manager, Contract Negotiations (Behavioral Health)-Louisiana Medicaid

CVS Health•Baton Rouge, LA

2d•$54,300 - $119,340•Hybrid

About The Position

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. In this Louisiana Medicaid individual contributor role, the Manager, Behavioral Health Contract Negotiations will serve as a behavioral health contracting subject matter resource for the Louisiana market, with responsibility for understanding the continuum of Louisiana Medicaid behavioral health services, applicable provider types and qualifications, and reimbursement structures necessary to build and maintain an adequate behavioral health network. This position will also support Network leadership in evaluating behavioral health network needs by level of care and service type; identifying access, capacity, and geographic gaps; and developing targeted recruitment and contracting strategies to address network deficiencies.

Requirements

3-5+ years behavioral health provider contracting experience, including negotiation and execution of agreements across multiple behavioral health provider types and levels of care.
Working knowledge of Louisiana Medicaid behavioral health services and provider requirements, including understanding of the provider types, licensure/credentialing requirements, service delivery requirements, and reimbursement considerations applicable to contracted services.
Knowledge of behavioral health levels of care and service settings, including inpatient psychiatric, residential, partial hospitalization, intensive outpatient, outpatient behavioral health, crisis services, substance use disorder treatment, and community-based behavioral health services.
Ability to evaluate a behavioral health provider's scope of services and qualifications against Medicaid requirements to determine which services and levels of care the provider is eligible to deliver and contract for.
Experience negotiating behavioral health reimbursement methodologies and contract terms, with the ability to evaluate rate proposals, financial impact, provider leverage, access needs, and market conditions.
Ability to interpret and operationalize Louisiana Medicaid requirements, managed care contract requirements, provider manuals, fee schedules, and applicable behavioral health guidance as they relate to provider contracting.
Strong communication, critical thinking, problem resolution and interpersonal skills
MS Office Suite proficiency
Ability to travel in assigned market up to 15% of the time
Resident of Louisiana and must be able to work in the office 1-2x/mo in the Baton Rouge office location.

Nice To Haves

Direct experience with the Louisiana Medicaid behavioral health provider and payer landscape, including contracting with behavioral health facilities, practitioners, substance use disorder providers, and community-based behavioral health providers.

Responsibilities

Serve as a behavioral health contracting subject matter resource for the Louisiana market.
Understand the continuum of Louisiana Medicaid behavioral health services, applicable provider types and qualifications, and reimbursement structures necessary to build and maintain an adequate behavioral health network.
Support Network leadership in evaluating behavioral health network needs by level of care and service type.
Identify access, capacity, and geographic gaps.
Develop targeted recruitment and contracting strategies to address network deficiencies.