Network Management Manager – LTSS Contracting

Job not on LinkedIn

October 18

🔔 Pennsylvania – Remote

Although this job is listed in Pennsylvania, this company may be open to hiring remote in other states.

💵 $60.3k - $132.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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CVS Health

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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.

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

📋 Description

• Recruit providers as needed to ensure attainment of network expansion and adequacy targets • Negotiate and execute contracts with larger and more complex, market-based group/system providers • Conduct extensive cold calling to recruit providers and build provider network • Manage the full contracting process, including pre- and post-signature review, language modifications, submission of contract packet to appropriate departments, and follow through to completion and participation • Collaborate with internal teams to resolve issues and meet network adequacy and expansion goals • Audit, build, and load contracts, agreements, amendments, and/or fee schedules in contract management systems • Conduct research, analysis, and audits to identify issues and propose solutions to protect data integrity and contract performance • Manage contract performance and support development of value-based relationships aligned with business strategies • Collaborate cross-functionally on provider compensation, pricing development, and reimbursement modeling activities • Attend JOC meetings with assigned health systems • Provide technical expertise for questions related to contracting systems and data • Perform data analysis to assess quality and meaning, identify trends, and visualize data using tools and techniques

🎯 Requirements

• Minimum 3 years of related experience with knowledge of basic negotiating skills • Proven working knowledge of standard provider contracts, terms, and language • High proficiency with Microsoft Office Suite (Word, Excel, Outlook) • Strong communication skills (written, verbal, and presentation) • Critical thinking, problem resolution, and interpersonal skills • Knowledge and experience with Medicaid programs, regulations, and provider requirements (preferred) • Experience with Quickbase and SharePoint (preferred) • Ability to identify and capitalize on opportunities to support program delivery (preferred) • In-depth knowledge of managed care industry practices and competitor strategies (preferred)

🏖️ Benefits

• Affordable medical plan options • 401(k) plan (including matching company contributions) • 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 different needs and preferences of colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access