Provider Contracting Senior Manager, National Specialty Value Based Care Partnerships

CVS Health • Ohio, IL

40d

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 SummaryAetna is recruiting for a Senior Manager, Value Based Contractor who will partner with business development and network leaders to build innovative and strategic provider relationships as part of the National Value Based Solutions Specialty Partnership team. You will work collaboratively across the Network and Clinical organizations to ensure speed to market and to support segment leaders with growing focus on our Specialty Medicare Advantage and Medicaid VBC portfolio.You will make an impact by:· Supporting the process for identifying, evaluating, and completing contracting with Specialty and Medicaid provider partners.· Developing relationships with leaders of specialty chronic kidney, oncology, polychronic/complex care, and emerging specialty types) or Medicaid provider organizations to design and execute on strategies for growth.· Develop and educate leaders on specialty landscapes and what financial models are being used across the industry.· Partnering with finance on the development of financial models and VBC contracts to support portfolio growth.· Partnering with Network and Segment teams to ensure deployment of VBC strategies are executed timely.· Perform market competitive analysis, engage contracting and clinical teams to create innovative value-based payment concepts.· Work with cross functional teams to create and initiate model solution development, pilot models, and ensure initial ROI for enterprise scaling.· Serve as a liaison among internal customers, operations, actuary, product, and analytic teams to ensure reimbursement initiatives meet the needs of internal and external customers.

Requirements

• 5+ years of experience in value-based care in contracting, provider relations, provider operations and/or solutions.
• Experience in Value Based Care financial models.
• Experience in Risk-based arrangements and Value-Based care in government services
• Adept at execution and delivery (planning, delivering, and supporting) skills.
• Strong organization and detail skills working in a highly matrixed environment.
• Ability to present and translate complex data into digestible information.

Responsibilities

• Supporting the process for identifying, evaluating, and completing contracting with Specialty and Medicaid provider partners.
• Developing relationships with leaders of specialty chronic kidney, oncology, polychronic/complex care, and emerging specialty types) or Medicaid provider organizations to design and execute on strategies for growth.
• Develop and educate leaders on specialty landscapes and what financial models are being used across the industry.
• Partnering with finance on the development of financial models and VBC contracts to support portfolio growth.
• Partnering with Network and Segment teams to ensure deployment of VBC strategies are executed timely.
• Perform market competitive analysis, engage contracting and clinical teams to create innovative value-based payment concepts.
• Work with cross functional teams to create and initiate model solution development, pilot models, and ensure initial ROI for enterprise scaling.
• Serve as a liaison among internal customers, operations, actuary, product, and analytic teams to ensure reimbursement initiatives meet the needs of internal and external customers.

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: Mid Level
• Industry: Ambulatory Health Care Services
• Number of Employees: 5,001-10,000 employees