Senior Manager, Provider Network Management

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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 • Manages contract performance • Contributes to provider compensation and pricing development activities and recommendations, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities. • May optimize interaction with assigned providers and internal business partners to manage relationships and ensure provider needs are met. • Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information. • Recruits’ providers as needed to ensure attainment of network expansion and adequacy targets. • Responsible for identifying and making recommendations to manage cost issues and supporting cost saving initiatives and/or settlement activities. • Assists with the design, development, management, and or implementation of strategic network configurations

🎯 Requirements

• Must reside in Indiana • 5-7 years related experience and comprehensive level of negotiating with individual or complex provider systems or groups and/or completion of General Management Development Program (GMDP) with a combination of other relevant experience • Knowledge of Indiana provider systems and market landscape. • Required to communicate w/internal/external parties by phone/in person; minimal travel to offsite provider groups and/or health system locations • Related experience in health operations, network relations and development, command of financials and pricing strategies, and sales interface. • Experience building and maintaining relationships with provider systems. • A successful track record managing and negotiating major provider contracts (move up) • In depth knowledge of various reimbursement structures and payment methodologies for both hospitals and providers/providers.

🏖️ Benefits

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