Provider Network Contracting Senior Manager (MO, IL)

CVS Health•Work At Home-Missouri, IN

7d•$67,900 - $182,549•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. Ideal candidate will sit in Central or Eastern Time Zone The Senior Manager negotiates, executes, conducts high level review and analysis, dispute resolution and/or settlement negotiations of contracts. Works with larger and more complex, market/regional/national based groups/systems in accordance with company standards to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals and cost initiatives. The Senior Manager will be responsible for contracting and implementing fee for service and value-based agreements with key physician groups, facilities, and ancillary providers to support commercial and individual exchange networks. This person will also work collaboratively with Aetna and CVS departments to identify initiatives to improve physician performance and quality of care provided to our members. Recruits providers as needed to ensure attainment of network expansion and adequacy targets. Accountable for cost arrangements within defined groups. Collaborates cross-functionally to manage 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

Minimum 7 years related experience and comprehensive level of negotiating with individual or complex provider systems or groups.
Proven working knowledge of provider financial issues and competitor strategies, large/complex contracting options, financial/contracting arrangements, and regulatory requirements.
Strong communication, critical thinking, problem resolution and interpersonal skills.

Nice To Haves

Commercial, individual exchange and Medicare experience.
Experience contracting with hospital systems and groups.
Advanced Excel experience including pivot tables and v-lookup function.

Responsibilities

Negotiates, executes, conducts high level review and analysis, dispute resolution and/or settlement negotiations of contracts.
Works with larger and more complex, market/regional/national based groups/systems in accordance with company standards to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals and cost initiatives.
Responsible for contracting and implementing fee for service and value-based agreements with key physician groups, facilities, and ancillary providers to support commercial and individual exchange networks.
Works collaboratively with Aetna and CVS departments to identify initiatives to improve physician performance and quality of care provided to our members.
Recruits providers as needed to ensure attainment of network expansion and adequacy targets.
Accountable for cost arrangements within defined groups.
Collaborates cross-functionally to manage 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.