Senior Manager, National Network Management – National Health Systems

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🔥 14 hours ago

🏄 California, Florida, +3 more states – Remote

🏄 California – Remote 🐊 Florida – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛰️ West Virginia – Remote

💵 $67.9k - $182.5k / year

⏰ Full Time

🟠 Senior

👔 Manager

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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

• Manage negotiation and development of contracts with larger and more complex national or regional-based providers and health systems • Design conceptual models and plan initiatives • Negotiate high-value/high-risk contracts • Conduct high-level contract review and analysis • Participate in dispute resolution and settlement negotiations • Manage contract performance • Support development and implementation of strategic provider networks • Support value-based contract relationships • Identify and manage cost issues and initiate cross-functional cost-saving or settlement activities • Collaborate cross-functionally on provider compensation, pricing development, contractual information, and reimbursement modeling • Represent the company with high-visibility constituents, including customers and community groups • Optimize interactions with assigned providers and internal business partners • Facilitate JOC meetings • Manage complex contractual provider relationships in support of national and regional network strategies • Serve as a subject matter expert for less experienced team members and internal partners • Resolve escalated issues involving claims payment, contract interpretation, and provider contract or demographic information • Evaluate, formulate, and implement national network strategic plans to achieve contracting targets and manage medical costs

🎯 Requirements

• Minimum of 7 years of related experience • Minimum of 5 years of successful expert-level negotiation experience with large or complex health systems • Comprehensive negotiation skills and successful track record negotiating contracts with individual or complex provider systems or groups • Critical thinking to maintain cost management and a fully engaged network of participating hospitals, ancillaries and providers • Healthcare industry experience with either a payer or provider • Strong communication, critical thinking, problem resolution and interpersonal skills • Working knowledge of value-based contracting • Internal Aetna system knowledge • Proven working knowledge of provider financial issues and competitor strategies, complex contracting options, financial/contracting arrangements and regulatory requirements • Bachelor's degree preferred or a combination of equivalent work experience and education • Ability to interpret contractual requirements including federal and state regulations and NCQA

🏖️ Benefits

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

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