Senior Provider Network Contracting Manager - Medicaid

CVS Health

1d

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 Reviews, analyzes, negotiates, and executes complex Medicaid contracts with health systems, physician groups, and behavioral health providers in accordance with company standards to maintain and enhance provider networks while meeting and exceeding accessibility, compliance, quality, and financial goals and cost initiatives. Collaborates cross-functionally to develop provider compensation and pricing strategies and manages contracts through language and compliance reviews. Serves as a liaison to internal colleagues to interpret contracts, drive cost savings, resolve claims and other service issues.

Requirements

• A minimum of 3 years work experience in a provider contracting or provider relations role, Medicaid and/or behavioral health experience preferred.
• Proven working knowledge of physician reimbursement methodologies and contracting strategies.
• Strong communication, critical thinking, project management and problem-solving skills.
• A willingness to actively interact with providers and have complex conversations.
• Working knowledge of Microsoft applications.
• Adept at negotiating complex healthcare provider contracts

Nice To Haves

• Working knowledge of QuickBase, QNEXT, PRMS and KIT systems preferred.

Responsibilities

• Reviews, analyzes, negotiates, and executes complex Medicaid contracts with health systems, physician groups, and behavioral health providers in accordance with company standards to maintain and enhance provider networks while meeting and exceeding accessibility, compliance, quality, and financial goals and cost initiatives.
• Collaborates cross-functionally to develop provider compensation and pricing strategies and manages contracts through language and compliance reviews.
• Serves as a liaison to internal colleagues to interpret contracts, drive cost savings, resolve claims and other service issues.

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