Senior Manager, Medicaid Network Management

Senior Manager, Medicaid Network Management at CVS Health in Boise, Idaho, United States Job Description 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 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 To view full details and how to apply, please login or create a Job Seeker account