Senior Manager, Network Management Hybrid, IL or MO

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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

Role will cover MO and Southern IL markets for Commercial, Medicare, and Individual & Family Plans. Candidates must reside in these markets and willing to go into office location within commutable distance.

∙ Negotiates, executes, conducts high level review and analysis of dispute resolution and/or settlement negotiations of contracts with larger and more complex, market/regional/national based group/system providers including but not limited to large PCP groups, pediatricians, advanced specialist groups, hospital based providers, ancillary providers, ambulatory surgical centers, behavioral health providers, etc. in accordance with company standards in order 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 issues/resolutions, related systems and information contained.
∙ Provide guidance and share expertise to others on the team.
∙ Understanding of Value Based contracting and negotiations
∙ Manage high level projects and recruitment initiatives with interdepartmental resources and/or cross functional stakeholders.
∙ Coordinates and Participates in Provider facing meetings-including but not limited to Joint Operating Committee meetings.
∙ Supports or assists with operational activities that may include, but are not limited to, database management and contract coordination.
∙ Organizing and transforming information into comprehensible structures.
∙ Using data to predict trends in the customer base and the consumer population as a whole
∙ Performing statistical analysis of data.
∙ Using tools and techniques to visualize data in easy-to-understand formats, such as diagrams and graphs.
∙ Preparing reports and presenting these to leadership.
∙ Engage with providers and quickly move the providers though contracting processes in order to ensure meeting network adequacy requirements.

Required Qualifications

∙ Minimum 3+ years’ experience in contracting/management experience.
∙ Minimum 3 years of proven knowledge of standard provider contracts, terms, and language.
∙ Minimum 3 years of solid negotiating and decision-making skills while executing national, regional, or market level strategies.
∙ In-depth knowledge of the managed care industry and practices, as well as a strong understanding of Aetna competitor strategies, practices, and financial/contracting arrangements.
∙ Ability to travel as needed (up to 25% travel).
∙ Demonstrated high proficiency with personal computer, mouse, keyboard and all MS Office suite applications (e.g., Outlook, Word, Excel, etc.).
∙ Solid decision-making skills while executing national, regional, and market level strategies.
∙ Possess critical thinking, problem resolution and interpersonal skills.
∙ Must possess critical thinking, p