Manager, Network Management – National Health Systems

Job not on LinkedIn

🔥 0 minutes ago

🏈 Alabama, Arizona, +43 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🏛️ District of Columbia – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🦬 Montana – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🌶️ New Mexico – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ☕ Washington – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote

💵 $54.3k - $159.1k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 0%

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

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

• 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 working relationships with physicians/providers and local network and patient management teams in Aetna markets • Establish and implement programs and innovative initiatives to advance Contract Negotiations initiatives • Forecast industry changes, conduct business impact assessments, and develop modification strategies using process improvement methodologies • Integrate cross-functional collaboration for provider compensation and pricing development activities, negotiation recommendations, and reimbursement modeling • Determine recommendations to manage cost issues and support cost-saving initiatives and settlement activities • Assist in network development, maintenance, and refinement activities and strategies supporting cross-market network management units • Coach more junior colleagues in techniques, processes, and responsibilities • Perform other duties and responsibilities as assigned by 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 that includes ACAS and HRP claim platforms, products, and benefits; patient management, provider relations, or claims management • Experience with Aetna systems (SCM, Smart Front End, Rate Inquiry, Contract Inquiry) preferred • Bachelor's degree preferred or a combination of professional work experience and education

🏖️ Benefits

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