Senior Network Contracting Negotiation Manager (Michigan)

CVS Health•Work At Home-Michigan, MI

1d•$75,400 - $165,954•Hybrid

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 Network Management Senior Manager applies highly-developed knowledge to negotiate complex Network contracts with healthcare providers, establishing 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. Implements 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.

Requirements

7+ years healthcare industry experience
5+ years related experience and comprehensive level of provider negotiating skills with successful track record negotiating contracts with complex provider systems or groups.
Must reside in Michigan
Critical thinking to maintain cost management and a fully engaged network of participating hospitals, ancillaries and providers.
Microsoft Office/Excel proficient
Ability to travel in assigned market up to 10-15% of the time as needed (Michigan).

Nice To Haves

Experience using contract management systems
Relevant experience and understanding of the local healthcare market and payer dynamics
Demonstrated analytical aptitude with proven capability to troubleshoot complex issues
Skilled at connecting data to daily execution of tasks

Responsibilities

Negotiate complex Network contracts with healthcare providers, establishing reimbursement rates, service agreements, and performance metrics.
Advise on provider performance, network adequacy, geographical coverage, and member satisfaction, and make necessary network modifications or expansions.
Implement improvement initiatives to ensure that network providers meet all applicable regulatory and quality standards.
Develop and expand the network, identifying and contracting with healthcare providers, including hospitals, physicians, specialists, and ancillary service providers.
Conduct market analysis, assess competitive positioning, and recommend strategies to maintain a competitive edge.
Interface with the finance team on budgeting, cost analysis, and financial forecasting, to manage the financial aspects of provider network management.
Consult with internal teams, including medical directors, operations managers, and network development professionals, to align provider network performance goals and objectives.
Provide continuous recommendations to senior leadership to guide decision-making and ensure close alignment with the organization's strategic goals and objectives.