Senior Manager, Network Management Behavioral Health (Southern CA, MT)

CVS Health • Wyoming, WY

39d

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

Requirements

• 5+ years related experience and comprehensive level of negotiating skills with successful track record negotiating contracts, including fee schedules, with individual or complex provider systems or groups
• Focus on behavioral health providers and facility types
• Proven working knowledge of provider financial issues and competitor strategies, complex contracting options, financial/contracting arrangements, and regulatory requirements
• Strong communication, critical thinking, problem resolution and interpersonal skills
• Experience in provider relations activities including claims issue resolution, adding new locations, general provider data maintenance and contract amendments
• Bachelor's Degree or equivalent combination of education and experience

Nice To Haves

• Candidates residing in the Pacific or Mountain time zones
• Experience supporting compliance/regulatory activities including network adequacy reporting, network gap mitigation activities and market expansions. Experience should include reviewing state bulletins, billing guides, etc.
• Previous experience in West coast region states a plus
• Experience in commercial, Medicare and Medicaid lines of business ideal

Responsibilities

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

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