Senior Manager, Medicaid Network Management (Maryland)

CVS Health • Edgewater, FL

9d

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 Negotiates, executes, conducts high level review and analysis, dispute resolution and/or settlement negotiations of contracts with larger and more complex, market-based group/system providers in accordance with company standards in order to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals and cost initiatives.

Requirements

• 7+ years related experience and expert level negotiation skills with successful track record negotiating contracts with large or complex provider systems.
• Strong communication, critical thinking, problem resolution and interpersonal skills.
• Proven working knowledge of provider financial issues and competitor strategies, complex contracting options, financial/contracting arrangements and regulatory requirements.
• Medicaid Network Management experience, preferably Maryland Medicaid program.
• Residing within the state of Maryland highly preferred, will consider other locations within the DMV area
• Bachelor’s Degree preferred or relevant professional experience.

Responsibilities

• Analyzes market needs and opportunities for network expansion, identifies gaps in the existing network, and proactively seeks new provider relationships to address those gaps.
• Ensures governance with healthcare regulations and contractual requirements, implementing strategies and processes to adhere to guidelines and requirements.
• Initiates moderate and/or complex contracting activities, including the collection of all required contract and credentialing documents, and obtains the necessary approval of non-standard rates and language modifications to contracts.
• Collaborates on negotiations or may handle contracting and re-contracting discussions with providers, provider groups and/or health systems.
• May participate in various internal and/or external meetings, serving as representative on behalf of the department.
• Supports or assists with operational activities that may include, but are not limited to, database management and contract coordination.
• Provides ongoing recommendations to leadership to guide decision-making and ensure alignment with the organization’s strategic goals.
• Coaches and mentors more junior level colleagues in contracting techniques, processes and responsibilities.

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: Senior
• Number of Employees: 5,001-10,000 employees