Manager, Network Management (National Health Systems)

CVS Health•Washington, NV

6d•$54,300 - $159,120

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.

Requirements

5+ years of provider contracting, claims management, or patient management experience.
5+ experience working with/or in a Claims environment
5+ experience that includes ACAS and HRP claim platforms, products, and benefits; patient management, provider relations, or claims management.

Nice To Haves

Experience with Aetna systems (SCM, Smart Front End, Rate Inquiry, Contract Inquiry)

Responsibilities

Constructs negotiation, execution, review, and analysis of contracts.
Delivers dispute resolution and settlement negotiations with providers.
Ensures contract performance aligns with accessibility, compliance, quality, financial, and cost goals.
Develop, maintain, and enhance working relationships with physicians/providers and local network and patient management teams in the markets with Aetna.
Establishes and implements programs and innovative initiatives for the organization to advance Contract Negotiations initiatives.
Forecasts changes within the Contract Negotiations industry, conducts business impact assessments, and develops modification strategies with the aid of process improvement methodologies.
Integrates cross-functional collaboration to contribute to provider compensation and pricing development activities and recommendations for negotiations and reimbursement modeling activities.
Determines recommendations to manage cost issues and support cost-saving initiatives and settlement activities.
Assists in the management of network development, maintenance, and refinement activities and strategies in support of cross-market network management units.
Coaches more junior colleagues in techniques, processes, and responsibilities.
Other duties and responsibilities as assigned by manager.