Senior Manager, Network Management

Job not on LinkedIn

🔥 0 minutes ago

🌶️ New Mexico, Oklahoma, +1 more states – Remote

🌶️ New Mexico – Remote 🌪️ Oklahoma – Remote 🤠 Texas – Remote

💵 $67.9k - $166k / year

⏰ Full Time

🟠 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

• Lead end-to-end contract negotiations, execution, and analysis with hospitals, physician groups, and smaller/local systems • Manage contract performance and develop and implement value-based arrangements aligned with organizational strategy • Identify, recruit, and onboard providers to meet network expansion and adequacy targets • Deliver competitive and sustainable cost arrangements • Partner cross-functionally on provider compensation strategy, pricing development, and reimbursement modeling • Analyze financial and operational data to identify cost-saving opportunities and execute initiatives with measurable impact • Represent the organization with providers, customers, and community stakeholders • Evaluate and contribute to provider network strategy aligned with state requirements, product needs, and cost management objectives • Optimize provider engagement and resolve complex escalations involving claims, contract interpretation, and provider data accuracy • Contract and implement fee-for-service and value-based agreements with physician groups, facilities, and ancillary providers • Collaborate with Aetna and CVS departments to improve physician performance and quality of care • Conduct high-level review and analysis, dispute resolution, and settlement negotiations of contracts

🎯 Requirements

• 7+ years of experience negotiating contracts with hospitals, facilities, and physician groups, including contract language development, rate proposal analysis, and identifying operational and financial improvement opportunities • 3+ years of experience in provider relationship management or related healthcare roles, with proven contract management expertise • Working knowledge of provider financial issues and competitor strategies • Knowledge of large/complex contracting options, financial/contracting arrangements, and regulatory requirements • Ability to leverage competitive market data, financial metrics, and detailed analysis to secure favorable contract outcomes • Strong communication, critical thinking, problem resolution, and interpersonal skills • Bachelor’s degree preferred or a combination of professional work experience and education • Commercial, individual exchange, and Medicare experience preferred • Experience contracting with hospital systems and groups preferred • Advanced Excel experience, including pivot tables and VLOOKUP, preferred • Strong preference for the candidate to sit in the Dallas-Fort Worth area or Oklahoma

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program • Award target in the company’s 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