Manager, Network Management – National Health Systems

Job not on LinkedIn

🔥 6 minutes ago

🇺🇸 United States – Remote

💵 $54.3k - $159.1k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 0%

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CVS Health Careers

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🏥 Healthcare

🛒 Retail

📦 Logistics

Healthcare • Retail • Logistics

CVS Health Careers is the recruitment and employer branding arm of CVS Health, showcasing job opportunities across the company's broad operations—pharmacy retail stores, pharmacy services, health care clinics, distribution warehouses, corporate functions and transportation. The careers site emphasizes purpose-driven work focused on improving access, affordability and quality of health care, and highlights a large workforce (300,000+ employees), inclusive culture, benefits, and hiring resources for applicants.

📋 Description

• Construct, negotiate, execute, review, and analyze contracts • Deliver dispute resolution and settlement negotiations with providers • Ensure contract performance aligns with accessibility, compliance, quality, financial, and cost goals • Develop, maintain, and enhance relationships with physicians/providers and local network and patient management teams in Aetna markets • Establish and implement programs and innovative initiatives for Contract Negotiations • Forecast industry changes, conduct business impact assessments, and develop modification strategies using process improvement methodologies • Integrate cross-functional collaboration for provider compensation, pricing development, negotiation recommendations, and reimbursement modeling • Recommend approaches to manage cost issues and support cost-saving initiatives and settlements • Assist with network development, maintenance, and refinement activities and strategies for cross-market network management units • Coach more junior colleagues • Perform other duties assigned by the manager

🎯 Requirements

• 5+ years of provider contracting, claims management, or patient management experience • 5+ years of experience working with or in a Claims environment • 5+ years of experience including ACAS and HRP claim platforms, products, and benefits; patient management, provider relations, or claims management • Bachelor's degree preferred or a combination of professional work experience and education • Experience with Aetna systems (SCM, Smart Front End, Rate Inquiry, Contract Inquiry) preferred

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • CVS Health bonus, commission or short-term incentive program in addition to base pay

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