Senior Manager, Medicaid Network Management

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Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Position Summary

The Medicaid senior manager, network management:

∙ Negotiates, executes, conducts high level review and analysis of dispute resolution and/or settlement negotiations of contracts with national providers including, but not limited to labs, Home Health, Home Infusion, Urgent Care Centers, vendor, in accordance with company standards to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals and cost initiatives.

∙ Recruit providers as needed to ensure attainment of network expansion goals, achieve regulatory and/or internal adequacy targets.

∙ Support health plan with expansion initiatives or other contracting activities as needed.

∙ Initiates, coordinates and own the contracting activities to fulfillment including receipt and processing of contracts and documentation and pre- and post-signature review of contracts and language modification according to Aetna’s established policies.

∙ Responsible for auditing, building, and loading contracts, agreements, amendments and/or fee schedules in contract management systems per Aetna’s established policies. .

∙ Conducts research, analysis and/or audits to identify issues and propose solutions to protect data, contract integrity and performance.

∙ Manages contract performance and supports the development and implementation of value-based contract relationships in support of business strategies.

∙ Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities.

∙ Provides Subject Matter Expert support for questions related to recruitment initiatives, contracting, provider issues/resolutions, related systems and information contained.

∙ Provide guidance and share expertise to others on the team.

∙ Understanding of Value Based contracting and negotiations

∙ Manage high level projects and recruitment initiatives with interdepartmental resources and/or cross functional stakeholders.

∙ May participates in JOC meetings.

∙ Supports or assists with operational activities that may include, but are not limited to, database management and contract coordination.

∙ Organizing and transforming information into comprehensible structures.

∙ Using data to predict trends in the customer base and the consumer population as a whole

∙ Performing statistical analysis of data.

∙ Using tools and techniques to visualize data in easy-to-understand formats, such as diagrams and graphs.

∙ Preparing reports and presenting these to leadership.

∙ Engage with providers and quickly move the providers though contracting processes in order to ensure meeting network adequacy requirements.

Required Qualifications

∙ 5 years of network contracting/management experience.

∙ Ability to travel as needed (up to 25% travel)

∙ 5 years of proven knowledge of standard provider contracts, terms and language

∙ 5 years of solid negotiating and decision-making skills while executing national, regional, or market level strategies.

∙ In-depth knowledge of the managed care industry and practices, as well as a strong understanding of competitor strategies, practices, and financial/contracting arrangements.

∙ Knowledge of ancillary contracting, i.e. DME, Lab, Infusion, Home Health, Urgent Care and Vendor

∙ Demonstrated high proficiency with personal computer, mouse, keyboard and all MS Office suite applications (e.g., Outlook, Word, Excel, etc.).

– Knowledge of Medicaid programs.

Preferred Qualifications

∙ Knowledge of Medicaid, Medicare and commercial programs and related subject matter preferred.

∙ Solid decision-making skills while executing national, regional, and market level strategies.

∙ Ability to forge long-lasting relationship.

∙ Possess critical thinking, problem resolution and interpersonal skills.

∙ Ability to identify and capitalize on opportunities to support program delivery.

∙ Strong communication skills (written, verbal and presentation).

∙ Highly organized and self-driven.

∙ Ability to work central time zone hours

Education Bachelors degree or equivalent professional work experience.

Pay Range

The typical pay range for this role is:

$75,400.00 – $165,954.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit Benefits | CVS Health (https://jobs.cvshealth.com/us/en/benefits)

We anticipate the application window for this opening will close on: 11/29/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.