Business Consultant, IC
CVS Health
Senior Network Provider Manager – National Medicaid Ancillary Contracting
CVS Health
full-time
Posted on:
Location Type: Remote
Location: Remote • Idaho, Texas • 🇺🇸 United States
Visit company websiteSalary
💰 $75,400 - $165,954 per year
Job Level
Senior
About the role
- Negotiates, executes, conducts high level review and analysis of dispute resolution and/or settlement negotiations of contracts with national providers including labs, Home Health, Home Infusion, Dialysis Centers, Transportation and Vision vendors
- Recruit providers as needed to ensure attainment of network expansion goals and regulatory/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
- Conducts research, analysis and/or audits to identify issues and propose solutions to protect data, contract integrity and performance
- Manages contract performance and supports development and implementation of value-based contract relationships
- Collaborates cross-functionally to manage provider compensation and pricing development activities and reimbursement modeling
- Provides Subject Matter Expert support for recruitment, contracting, provider issues/resolutions, related systems and information
- Provide guidance and share expertise to others on the team
- Manage high level projects and recruitment initiatives with interdepartmental resources and cross functional stakeholders
- May participate in JOC meetings and supports operational activities including database management and contract coordination
- Organizing and transforming information into comprehensible structures, using data to predict trends, performing statistical analysis, visualizing data, preparing reports and presenting to leadership
- Engage with providers and quickly move providers through contracting processes to ensure meeting network adequacy requirements
Requirements
- 5+ years of network contracting/management experience
- 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
- Ability to travel as needed (up to 25% travel)
- In-depth knowledge of the managed care industry and practices
- Knowledge of ancillary contracting, i.e. DME, Lab, Infusion, Home Health, Urgent Care and Vendor
- Knowledge of Medicaid programs
- Demonstrated high proficiency with personal computer, mouse, keyboard and all MS Office suite applications (e.g., Outlook, Word, Excel, etc.)
- 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
- Bachelor's degree or equivalent professional work experience
Benefits
- Affordable medical plan options
- A 401(k) plan (including matching company contributions)
- Employee stock purchase plan
- Eligible for a CVS Health bonus, commission or short-term incentive program
- Award target in the company’s equity award program
- 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
- Competitive wages
ATS Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
network contractingcontract managementnegotiatingprovider contractsstatistical analysisdata visualizationcontract auditingreimbursement modelingcontract language modificationprovider compensation
Soft skills
decision-makingcritical thinkingproblem resolutioninterpersonal skillscommunication skillsorganizational skillsself-drivenrelationship buildingcollaborationproject management
