Network Management Manager- Pennsylvania LTSS Contracting

CVS Health • Home, PA

29d

About The Position

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position Summary:This role is responsible for recruiting providers and managing the end-to-end contracting process to ensure timely participation in our network. The position requires a high volume of cold calls, persistent follow-up, and strong organizational skills to move contracts from initiation through execution. The ideal candidate will have negotiation skills, basic contract knowledge, and the ability to manage multiple priorities in a fast-paced environment.

Requirements

• Minimum 3 years of related experience with knowledge of basic negotiating skills.
• Proven working knowledge of standard provider contracts, terms, and language.
• High proficiency with Microsoft Office Suite (Word, Excel, Outlook).
• Strong communication skills (written, verbal, and presentation).
• Critical thinking, problem resolution, and interpersonal skills.
• Candidates must reside in the state of Pennsylvania.
• Travel may be required up to 10%.

Nice To Haves

• Knowledge and experience with Medicaid programs, regulations, and provider requirements.
• Experience with Quickbase and SharePoint.
• Ability to identify and capitalize on opportunities to support program delivery.
• In-depth knowledge of managed care industry practices and competitor strategies.

Responsibilities

• Recruit providers as needed to ensure attainment of network expansion and adequacy targets.
• Negotiate and execute contracts with larger and more complex, market-based group/system providers.
• Conduct extensive cold calling to recruit providers and build provider network
• Manage the full contracting process, including pre- and post-signature review, language modifications, when appropriate, submission of contract packet to appropriate departments, follow through to completion and participation.
• Collaborate with internal teams to resolve issues and meet network adequacy and expansion goals.
• Audit, build, and load contracts, agreements, amendments, and/or fee schedules in contract management systems.
• Conduct research, analysis, and audits to identify issues and propose solutions to protect data integrity and contract performance.
• Manage contract performance and support development of value-based relationships aligned with business strategies.
• Collaborate cross-functionally on provider compensation, pricing development, and reimbursement modeling activities.
• Attend JOC meetings with assigned health systems.
• Provide technical expertise for questions related to contracting systems and data.
• Perform data analysis to assess quality and meaning, identify trends, and visualize data using tools and techniques.

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Industry: Ambulatory Health Care Services
• Number of Employees: 5,001-10,000 employees