Senior Manager, Network Management – Keystone Market

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🔥 0 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $75.4k - $166k / year

⏰ Full Time

🟠 Senior

👔 Manager

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

Healthcare Insurance • Retail • Wellness

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Negotiate, execute, and analyze complex provider contracts, including dispute resolution and settlement negotiations • Manage contract performance and support value-based arrangements aligned to business strategy • Drive network expansion and adequacy through provider recruitment and targeted strategies • Accountable for cost arrangements and aligning contracts with financial goals • Collaborate cross-functionally on pricing, compensation, and reimbursement modeling activities • Conduct contract analysis to identify cost savings and optimization opportunities • Resolve escalated issues including claims, contract interpretation, and provider data accuracy • Ensure compliance with regulatory requirements and company standards • Serve as SME and provide guidance to team members • Support network development and strategic configuration initiatives

🎯 Requirements

• 7–10 years of experience in healthcare contracting or network management • Strong understanding of provider financials and reimbursement methodologies • Proven negotiation, communication, and cross-functional collaboration skills • Familiarity with the Keystone market preferred • Experience working with Aetna internal systems preferred • Strong proficiency in Microsoft Office applications • Background in value-based care agreements • Experience across Commercial, Medicare, and Medicaid lines of business.

🏖️ Benefits

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