Senior Network Management Manager

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

The Sr Manager of Network Management for OhioRISE is responsible for driving the development and implementation of network strategies, managing client contractual commitments and executing pricing strategies. The Sr Manager will also monitor and be accountable for key metrics to ensure high-quality customer relationships. The Sr Manager is responsible for establishing and maintaining productive value-based relationships with key network providers. 

The Sr Manager is responsible for developing and managing the OhioRISE Provider and Care Management Entity (CME) Network as outlined below:

• Accountable for building strategic relationships with our provider and CME partners to develop innovative value-based solutions to meet total cost and quality goals.

• Responsible for developing alternative payment models, identifying and planning new initiatives, and negotiating high value/risk contracts with the most complex arrangement structures, which requires:

  • understanding providers’ volume and cost structure

  • working cross functionally to identify the levers and critical negotiation points

  • aligning negotiation strategies and tactics with network accessibility, quality, compliance, and financial performance goals

• Works with key internal teams to develop a value-based strategic plan and oversee contract performance with targeted provider groups to ensure we meet objectives for value-based provider agreements.

• Evaluates and implements strategic network plans to achieve contracting targets and manage medical costs through effective contracting.

• Provides assistance and support to other departments, as needed, to obtain crucial or required information from providers, such as HEDIS, Credentialing, etc.

• Facilitates and attends external provider meetings and negotiations, as needed.

• Manages operational aspects of the team, subsequently implementing workforce and succession plans to meet business goals and objectives.

• Guides management for individual performance evaluations aimed to provide critical feedback for skills development and depth of work area experience.

• Contributes to business objectives by leading and establishing new initiatives for the strategic planning functions within the organization.

• Implements strategic and operational initiatives in collaboration with executive leadership, managing end-to-end accountability from initial vision through to comprehensive planning and follow-up.

• Develop and manage team to achieve key drivers of business performance and identify gaps or opportunities to accelerate network growth and performance.

• Develops collaborative relationships with leaders and key stakeholders within the system to obtain information and content from providers and colleagues to foster successful network management.

• Communicates with top management about continuous improvement opportunities and establishing and maintaining best practices.

• Works strategically across the organization to ensure business partners and stakeholders have full knowledge of process excellence to deliver effective functional support

• Communicates strategically regarding insights on client dynamics, competitor strategies, and industry disruptions to guide strategic decision-making in the healthcare sector.

• Advises on organization standards, helps set performance goals, and evaluates individual and team performance to ensure the achievement of Business Strategy objectives.

Required Qualifications

• 7+ years of related experience and comprehensive level of negotiating skills with successful track record negotiating value-based contracts with IPAs, large complex provider systems or groups, hospitals and large physician and risk bearing entities.

• Experience managing a team of people.

Preferred Qualifications

• Strong communication, negotiation, and presentation skills

• Ability to work in a matrixed organization and gain consensus and share information to various interested parties

• Adept at execution and delivery (planning, delivering, and s