Senior Manager, Contracting and Network Management Remote Indiana

CVS Health

7d•Remote

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

Must reside in Indiana
Minimum 7+ years related experience and comprehensive level of negotiating with individual or complex provider systems or groups.
Knowledge of Indiana provider systems and market landscape.
Required to communicate w/internal/external parties by phone/in person; minimal travel to offsite provider groups and/or health system locations
Related experience in health operations, network relations and development, command of financials and pricing strategies, and sales interface.
Experience building and maintaining relationships with provider systems.
A successful track record managing and negotiating major provider contracts
In depth knowledge of various reimbursement structures and payment methodologies for both hospitals and providers/providers.

Nice To Haves

Knowledge and experience with value-based contracting and accountable care models.
In-depth knowledge of managed care business, regulatory /legal requirements.
Medicare Advantage knowledge and experience

Responsibilities

Negotiates, executes, reviews, and analyzes contracts and/or handles dispute resolution and settlement negotiations focused on health systems in Indiana.
Manages contract performance.
Contributes to provider compensation and pricing development activities and recommendations, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities.
May optimize interaction with assigned providers and internal business partners to manage relationships and ensure provider needs are met.
Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.
Recruits providers as needed to ensure attainment of network expansion and adequacy targets.
Responsible for identifying and making recommendations to manage cost issues and supporting cost saving initiatives and/or settlement activities.
Assists with the design, development, management, and/or implementation of strategic network configurations.