CVS Health
Senior Manager, Behavior Provider Network Management- (NC, SC, TN)
CVS Health, Raleigh, North Carolina, United States, 27601
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, a Fortune six company, as the Network Management Senior Manager. In this individual contributor role, you will negotiate with, execute high-level review and analysis, manage dispute resolution and settlement negotiations of contracts with large and complex, market-based, behavioral health groups and facilities providers. You will manage contract performance and support the development and implementation of strategic, traditional contracts and value-based contract relationships.
**Role must sit in the East or Mid-South Region (one of these locations NC, SC, or TN highly preferred)
Key deliverables in this role include:
· Recruit providers as needed to ensure attainment of network expansion and adequacy targets.
· Collaborate 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 initiating appropriate cost saving initiatives and settlement activities.
· Assist with the design, development, management, and or implementation of strategic network configurations and integration activities.
· Assist with the market compliance activities, including State reporting, mitigation plan design, development, and implementation.
· Manage contract performance and drive the development and implementation of value-based contract relationships in support of business strategies.
· Represent Aetna with high visibility constituents, including customers and community groups.
· Promote collaboration with internal partners.
· Evaluate, formulate, and implement the provider network strategic plans to achieve contracting targets and manage medical costs through effective provider contracting to meet state contract and product requirements.
· Optimize interaction with assigned providers and internal business partners to facilitate relationships and ensure provider needs are met.
To be successful, you will utilize your strong communication, critical thinking, problem resolution and interpersonal skills.
· Adept at execution and delivery (planning, delivering, and supporting) skills.
· Adept at business intelligence
· Adept at collaboration and teamwork
· Adept at growth mindset (agility and developing yourself and others) skills.
Required Qualifications
· Must be well versed with the behavioral health provider market in the East and/or Mid-South and must reside in East or Mid-South, preferably NC, SC, or TN and may visit facilities.
· Commercial, Medicare, and/or Medicaid knowledge
· Minimum 5+ years related experience, proven and proficient managed care network negotiating skills.
· Contracting for large facilities and/or provider groups.
· Proven working knowledge of competitor strategies, complex contracting options, financial/contracting arrangements, and regulatory requirement.
Education
· Bachelor's degree preferred/specialized training/relevant professional qualification
Pay Range
The typical pay range for this role is:
$67,900.00 - $199,144.80
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: 11/18/2024
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.
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, a Fortune six company, as the Network Management Senior Manager. In this individual contributor role, you will negotiate with, execute high-level review and analysis, manage dispute resolution and settlement negotiations of contracts with large and complex, market-based, behavioral health groups and facilities providers. You will manage contract performance and support the development and implementation of strategic, traditional contracts and value-based contract relationships.
**Role must sit in the East or Mid-South Region (one of these locations NC, SC, or TN highly preferred)
Key deliverables in this role include:
· Recruit providers as needed to ensure attainment of network expansion and adequacy targets.
· Collaborate 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 initiating appropriate cost saving initiatives and settlement activities.
· Assist with the design, development, management, and or implementation of strategic network configurations and integration activities.
· Assist with the market compliance activities, including State reporting, mitigation plan design, development, and implementation.
· Manage contract performance and drive the development and implementation of value-based contract relationships in support of business strategies.
· Represent Aetna with high visibility constituents, including customers and community groups.
· Promote collaboration with internal partners.
· Evaluate, formulate, and implement the provider network strategic plans to achieve contracting targets and manage medical costs through effective provider contracting to meet state contract and product requirements.
· Optimize interaction with assigned providers and internal business partners to facilitate relationships and ensure provider needs are met.
To be successful, you will utilize your strong communication, critical thinking, problem resolution and interpersonal skills.
· Adept at execution and delivery (planning, delivering, and supporting) skills.
· Adept at business intelligence
· Adept at collaboration and teamwork
· Adept at growth mindset (agility and developing yourself and others) skills.
Required Qualifications
· Must be well versed with the behavioral health provider market in the East and/or Mid-South and must reside in East or Mid-South, preferably NC, SC, or TN and may visit facilities.
· Commercial, Medicare, and/or Medicaid knowledge
· Minimum 5+ years related experience, proven and proficient managed care network negotiating skills.
· Contracting for large facilities and/or provider groups.
· Proven working knowledge of competitor strategies, complex contracting options, financial/contracting arrangements, and regulatory requirement.
Education
· Bachelor's degree preferred/specialized training/relevant professional qualification
Pay Range
The typical pay range for this role is:
$67,900.00 - $199,144.80
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: 11/18/2024
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.