Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
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:
Do you want to make a large impact in your next role? Join Aetna/CVS Health, as the Network Management Senior Manager. In this role, you will manage contract performance and support the development and implementation of strategic and value-based relationships across national and innovative providers of behavioral healthcare. You will be asked to innovate on novel and industry leading value-based contracts, conduct high-level reviews and analysis, and manage dispute resolution and settlement negotiations of contracts, with large and complex, national, behavioral health groups and facility providers.
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*Role is for national behavioral health contracting and strategic partnerships Key deliverables in this role include:
- Guides development of holistic solutions and strategic plans by negotiating and executing contracts with the most complex, market /region/national, largest group/system or highest value/volume of spend providers with significant financial implications.
- Manages contract performance and drives the development and implementation of value-based relationships in support of business strategies.
- Recruits providers as needed to ensure attainment of network expansion and adequacy targets.
- Accountable for cost arrangements within defined groups through collaborating 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.
- Responsible for identifying and managing cost issues and collaborating cross functionally to execute significant cost saving initiatives. Represents company with high visibility constituents, including customers and community groups. Promotes collaboration with internal partners.
- Evaluates, helps formulate, and implements the provider network strategic plans to achieve contracting targets and manage medical costs through effective provider contracting to meet state contract and product requirements.
- Collaborates with internal partners to assess effectiveness of tactical plan in managing costs. May optimize interaction with assigned providers and internal business partners to facilitate 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.
- Adept at execution and delivery (planning, delivering, and supporting) skills
- Adept at business intelligence
- Adept presentation skills
- Adept at collaboration and teamwork
- Adept at growth mindset (agility and developing yourself and others) skills
- Adept at internal and external relationship management
- Expansive Commercial, Medicare, and/or Medicaid knowledge
- Minimum 5+ years related experience, proven and proficient managed care network negotiating skills preferably with large facilities or provider groups
- Proven working knowledge of competitor strategies, complex contracting options, financial/contracting arrangements, and regulatory requirements
- Minimum 3+ years contracting for large facilities or provider groups
- Proven working knowledge of value based (VBC) and pay for performance (P4P) behavioral health contracting solutions
- Experience in evaluation of cost analysis, quality care, and health care outcomes reporting
- Experience with behavioral health Institutes of Quality (IOQ)
- Must be well versed with the virtual and national behavioral health provider market
- Familiar with provider and contracting applications and systems such as SCM and/or EPD
- Comfortable with creating decks and PP presentations
The typical pay range for this role is:$67,900.00 - $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 HealthWe anticipate the application window for this opening will close on: 01/10/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.