Manager, Contract Negotiations (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, Contract Negotiations will recruit, negotiate and execute physical and behavioral health provider contracts to ensure attainment of Aetna Better Health of Louisiana network expansion and adequacy targets. Optimize interaction with assigned providers and internal business partners to facilitate relationships and ensure provider needs are met. Responsible for identifying and managing cost issues and initiating appropriate cost saving initiatives and/or settlement activities. Assists with the design, development, management, and implementation of strategic network configurations and integration activities. Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information. Manages complex, contractual relationships with providers according to prescribed guidelines in support of national and regional network strategies. Collaborates 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.

Requirements

3-5 years of related experience with successful track record negotiating managed care provider contracts with physician groups, hospitals, and/or ancillary services
In-depth knowledge of the managed care industry and practices, as well as a strong understanding of strategies and financial/contracting reimbursement methodologies
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 as needed
Resident of Louisiana
Hybrid (able to work in Baton Rouge office at least 1-2x/mo)

Nice To Haves

Knowledge of Louisiana Medicaid provider and payor landscape

Responsibilities

Recruit, negotiate and execute physical and behavioral health provider contracts to ensure attainment of Aetna Better Health of Louisiana network expansion and adequacy targets.
Optimize interaction with assigned providers and internal business partners to facilitate relationships and ensure provider needs are met.
Responsible for identifying and managing cost issues and initiating appropriate cost saving initiatives and/or settlement activities.
Assists with the design, development, management, and implementation of strategic network configurations and integration activities.
Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.
Manages complex, contractual relationships with providers according to prescribed guidelines in support of national and regional network strategies.
Collaborates 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.