Contract Negotiation Senior Manager – Illinois Medicaid (Hybrid)

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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 Contract Negotiation Senior Manager negotiates, executes, conducts deep-dive review and analysis of dispute resolution and/or settlement negotiations of contracts with larger and more complex, market/regional/national based group/system providers including but not limited to Health Systems/Hospitals, large PCP groups, pediatricians, advanced specialist groups, hospital based providers, ancillary providers, ambulatory surgical centers, behavioral health providers, etc. in accordance with company standards in order to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals and cost initiatives

Other Responsibilities Include but are not limited to:

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

This is an individual contributor role

Required Qualifications

7-10 years of network contracting/management experience

Ability to travel as needed (up to 10-25% travel)

In-office Attendance 2-3 days per week (Downers Grove, IL or Downtown (Loop) Chicago, IL)

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 strategies, practices, and financial/contracting arrangements

Must possess critical thinking, problem resolution and interpersonal skills

Highly organized and self-driven

Preferred Qualifications

Please replace this section with the Preferred Job Qualifications

Ability to identify and capitalize on opportunities to support program delivery

Communication Skills – Strong communication skills (written, verbal and presentation)

Ability to forge meaningful, long-lasting relationships with providers

Knowledge of Medicaid programs and related subject matter

Education

Bachelor’s degree desired or equivalent professional work experience

Pay Range

The typical pay range for this role is:

$82,940.00 – $182,549.40

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: 11/30/2024

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.