Senior Manager, Network Management

CVS Health • Kansas City, MO

11d • $82,940 - $182,549

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. Position Summary The Senior Manager will manage the strategy development and execution of Contracts with providers and delivery systems to participate in Aetna managed care networks. Work will include, but not be limited to active negotiations, vbc engagement, execution of contract activities, strategy development, relationship management, dispute resolution and other duties as related to network activity. Direct provider engagement will include larger and more complex, market/regional groups/systems, and facilities, in accordance with company standards to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals and cost initiatives. Coordination of activities will involve external constituents, provider partners and internal cross-functional teams (Sales, PDS, Claims, PDS, etc). Contract Management: Initiate, coordinate, and own the contracting activities to fulfillment, including receipt and processing of contracts and documentation. Conduct pre- and post-signature review of contracts and language modifications according to established policies. Auditing and Loading: Responsible for auditing, building, and loading contracts, agreements, amendments, and fee schedules in contract management systems per established policies. This will include multiple systems, primarily SCM. Research and Analysis: Conduct research, analysis, and audits to identify issues and propose solutions to protect data, contract integrity, and performance. Contract Performance Management: Manage contract performance and support the development and implementation of value-based contract relationships in alignment with business strategies Cross-Functional Collaboration: Collaborate cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and review and analysis of reports as part of negotiation and reimbursement modeling activities. Assist with strategy development and facilitate activities as required to assist contingent worker activities. Subject Matter Expertise: Provide expert support for questions related to recruitment initiatives, contracting, provider issues/resolutions, related systems, and information contained. Share expertise and guidance with team members. Value-Based Contracting: Understand and manage value-based contracting and negotiations, as warranted. Project Management: Manage high-level projects and initiatives with inter-departmental resources and cross-functional stakeholders. Provider Meetings: Coordinate and participate in provider-facing meetings, including but not limited to Joint Operating Committee meetings, if warranted. Operational Support: Assist with operational activities such as database management and contract coordination. Data Management: Organize and transform information into comprehensible structures. Use data to predict trends in the customer base and the consumer population. Perform statistical analysis of data and visualize data in easy-to-understand formats, such as diagrams and graphs. Prepare reports and present findings to leadership. Provider Engagement: Engage with providers and efficiently move them through contracting processes in order to maintain robust network adequacy requirements.

Requirements

• Minimum 5 years related experience and comprehensive level of negotiating managed care contracts with individuals, complex provider systems, etc
• Proven working knowledge of healthcare related provider financial issues and competitor strategies, large/complex contracting options, financial/contracting arrangements, and regulatory requirements
• Strong skills focused on communication, negotiations, critical thinking, problem resolution, competitor strategies
• Highly effective in WAH environment and proficient with MS Office (experienced with pivot tables, v-lookup, etc)

Nice To Haves

• Solid decision-making skills while executing national, regional, and market-level strategies
• Experience in negotiating managed care (including vbc) contract terms across the full spectrum of provider types
• Proficient with Aetna internal systems specific to contracting (SCM)

Responsibilities

• Manage the strategy development and execution of Contracts with providers and delivery systems to participate in Aetna managed care networks.
• Active negotiations, vbc engagement, execution of contract activities, strategy development, relationship management, dispute resolution and other duties as related to network activity.
• Direct provider engagement will include larger and more complex, market/regional groups/systems, and facilities, in accordance with company standards to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals and cost initiatives.
• Coordination of activities will involve external constituents, provider partners and internal cross-functional teams (Sales, PDS, Claims, PDS, etc).
• Initiate, coordinate, and own the contracting activities to fulfillment, including receipt and processing of contracts and documentation.
• Conduct pre- and post-signature review of contracts and language modifications according to established policies.
• Responsible for auditing, building, and loading contracts, agreements, amendments, and fee schedules in contract management systems per established policies.
• Conduct research, analysis, and audits to identify issues and propose solutions to protect data, contract integrity, and performance.
• Manage contract performance and support the development and implementation of value-based contract relationships in alignment with business strategies
• Collaborate cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and review and analysis of reports as part of negotiation and reimbursement modeling activities.
• Assist with strategy development and facilitate activities as required to assist contingent worker activities.
• Provide expert support for questions related to recruitment initiatives, contracting, provider issues/resolutions, related systems, and information contained.
• Share expertise and guidance with team members.
• Understand and manage value-based contracting and negotiations, as warranted.
• Manage high-level projects and initiatives with inter-departmental resources and cross-functional stakeholders.
• Coordinate and participate in provider-facing meetings, including but not limited to Joint Operating Committee meetings, if warranted.
• Assist with operational activities such as database management and contract coordination.
• Organize and transform information into comprehensible structures.
• Use data to predict trends in the customer base and the consumer population.
• Perform statistical analysis of data and visualize data in easy-to-understand formats, such as diagrams and graphs.
• Prepare reports and present findings to leadership.
• Engage with providers and efficiently move them through contracting processes in order to maintain robust network adequacy requirements.

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