Director, Regional Operations
Imagine Pediatrics
Senior Manager, Medicaid Network Management
CVS Health
full-time
Posted on:
Location Type: Remote
Location: Remote • Maryland • 🇺🇸 United States
Visit company websiteSalary
💰 $82,940 - $182,549 per year
Job Level
Senior
About the role
- Negotiates, executes, conducts high level review and analysis, dispute resolution and/or settlement negotiations of contracts with larger and more complex, market-based group/system providers
- Analyzes market needs and opportunities for network expansion and identifies gaps in existing network
- Ensures governance with healthcare regulations and contractual requirements and implements strategies and processes to adhere to guidelines and requirements
- Initiates moderate and/or complex contracting activities, including collection of required contract and credentialing documents and obtains approval of non-standard rates and language modifications
- Collaborates on negotiations or may handle contracting and re-contracting discussions with providers, provider groups and/or health systems
- May participate in various internal and/or external meetings as representative of the department
- Supports or assists with operational activities including database management and contract coordination
- Provides recommendations to leadership to guide decision-making and ensures alignment with organization strategic goals
- Coaches and mentors more junior level colleagues in contracting techniques, processes and responsibilities
Requirements
- 7+ years related experience and expert level negotiation skills with successful track record negotiating contracts with large or complex provider systems
- Strong communication, critical thinking, problem resolution and interpersonal skills
- Proven working knowledge of provider financial issues and competitor strategies, complex contracting options, financial/contracting arrangements and regulatory requirements
- Medicaid Network Management experience, preferably Maryland Medicaid program
- Residing within the state of Maryland highly preferred, will consider other locations within the DMV area
- Bachelor’s Degree preferred or relevant professional experience
Benefits
- Affordable medical plan options
- a 401(k) plan (including matching company contributions)
- an employee stock purchase plan
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
- Paid time off
- Flexible work schedules
- Family leave
- Dependent care resources
- Colleague assistance programs
- Tuition assistance
- Retiree medical access
- CVS Health bonus, commission or short-term incentive program eligibility
- Award target in the company’s equity award program
ATS Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
contract negotiationcontract analysisdispute resolutioncredentialingdatabase managementfinancial arrangementsregulatory compliancenetwork expansion analysiscontracting techniquesprovider financial issues
Soft skills
communicationcritical thinkingproblem resolutioninterpersonal skillscoachingmentoringcollaborationleadershipdecision-makingstrategic alignment
