Manager, Network Relations

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🥔 Idaho, Ohio, +1 more states – Remote

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

💵 $60.3k - $132.6k / year

⏰ Full Time

🟡 Mid-level

🟠 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

• 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

🎯 Requirements

• 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

🏖️ Benefits

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