Manager, Network Relations

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🕒 Junho 7

🥔 Idaho, Ohio, +1 estados a mais – Remoto

🥔 Idaho – Remote 🏈 Ohio – Remote 🤠 Texas – Remote

💵 $60.300 - $132.600 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

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CVS Health

SiteLinkedInTodas as Vagas

10.000+ funcionários

Fundada em 1963

⚕️ Seguro de Saúde

🛒 Varejo

🧘 Bem-estar

Healthcare Insurance • Retail • Wellness

CVS Health é uma empresa líder de saúde nos Estados Unidos, dedicada a ampliar o acesso e a acessibilidade ao cuidado. A empresa adota uma abordagem abrangente que inclui serviços de saúde, seguro saúde e gestão de benefícios farmacêuticos (PBM). Por meio de suas subsidiárias, como Aetna e CVS Caremark, a CVS Health oferece uma variedade de serviços que promovem o bem-estar, a gestão de condições de saúde e a cobertura acessível de medicamentos prescritos. A CVS Health opera farmácias de bairro, oferece serviços de farmácia por correspondência e gerencia programas de medicamentos de especialidade, com o objetivo de tornar o cuidado com a saúde conveniente e acessível para todos. Movida pela missão de conectar pessoas a serviços essenciais de cuidado, a CVS Health está comprometida em fomentar comunidades mais saudáveis e apoiar o bem-estar de todas as pessoas.

Descrição

• Negotiates, executes, reviews, and analyzes contracts and/or handles dispute resolution and settlement negotiations with solo, small group, or local providers • Manages contract performance in support of network quality, availability, and financial goals and strategies • Recruits providers as needed to ensure attainment of network expansion and adequacy targets • Collaborates cross-functionally to contribute to provider compensation and pricing development activities and recommendations • Identifies and recommends solutions to manage cost issues and supports cost-saving initiatives • Provides network development, maintenance, and refinement strategies in support of the cross-market network management unit • Assists with the design, development, management, and/or implementation of strategic network configurations and integration activities • Optimizes interactions with assigned providers and internal business partners to manage relationships • Ensures resolution of escalated issues related to claims payment, contract interpretation, and the accuracy of provider contract or demographic information

🎯 Requisitos

• 5+ years of experience negotiating contracts with ancillary providers, facilities, and physician groups • Expertise in contract language development, rate proposal analysis, and operational and financial improvement opportunities • 3+ years of experience in provider relationship management or related healthcare roles • Understanding of common contract provisions, provider reimbursement methodologies and terms, and industry-standard payment policies and practices • Understanding of provider financial issues, regulatory requirements, and competitor strategies • Proficiency with Microsoft Office suite applications (e.g., Outlook, Word, Excel) • Ability to build collaborative relationships with providers and work cross-functionally to resolve complex contract issues • Highly organized, with the ability to manage and prioritize multiple negotiations and tasks to meet deadlines • Bachelor's degree or a combination of professional work experience and education

🏖️ Benefícios

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • other resources, based on eligibility