Senior Manager, Value-Based Care Contracting (Louisiana)

CVS Health•Work At Home-Louisiana, LA

7d•$67,900 - $149,328•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. The Senior Manager of Network Management is a critical role in advancing the organization’s Value-Based Contracting (VBC) strategy for the Louisiana Medicaid Market. This position is essential to developing and managing provider relationships that drive improved health outcomes, cost efficiency, and compliance with state and federal Medicaid obligations.

Requirements

Minimum 7 years of experience in provider network management, contract negotiations, or value-based contracting within Medicaid or managed care programs.
Strong understanding of Medicaid reimbursement models, value-based care, and risk sharing arrangements.
Demonstrated ability to analyze financial and quality performance data and implement process improvements.
Experience with provider performance measurement, quality improvement and building strong provider partnerships.
Reside in the Louisiana market.

Nice To Haves

Adept at problem solving and decision-making skills
Adept at collaboration and teamwork
Adept at growth mindset (agility and developing yourself and others) skills
Adept at execution and delivery (planning, delivering, and supporting) skills
Adept at business intelligence

Responsibilities

Directs groups to manage provider contract performance and supports the development and implementation of strategic, value-based contract relationships.
Applies highly developed knowledge to negotiate Network contracts with healthcare providers, establish reimbursement rates, service agreements, and performance metrics.
Advises on provider performance, network adequacy, geographical coverage, and member satisfaction, and makes necessary network modifications or expansions.
Implement improvement initiatives to ensure that network providers meet all applicable regulatory and quality standards.
Develops and expands the network, identifying and contracting with healthcare providers, including hospitals, physicians, specialists, and ancillary service providers.
Conducts market analysis, assesses competitive positioning, and recommends strategies to maintain a competitive edge.
Interfaces with the finance team on budgeting, cost analysis, and financial forecasting, to manage the financial aspects of provider network management.
Consults with internal teams, including medical directors, operations managers, and network development professionals, to align provider network performance goals and objectives.
Provides continuous recommendations to senior leadership to guide decision-making and ensure close alignment with the organization's strategic goals and objectives.