Senior Manager, Network Management

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 Senior Manager will manage the strategy development and execution of Contracts with providers and delivery systems to participate in Aetna managed care networks. Work will include, but not be limited to active negotiations, vbc engagement, execution of contract activities, strategy development, relationship management, dispute resolution and other duties as related to network activity. Direct provider engagement will include larger and more complex, market/regional groups/systems, and facilities, in accordance with company standards to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals and cost initiatives. 

Coordination of activities will involve external constituents, provider partners and internal cross-functional teams (Sales, PDS, Claims, PDS, etc). 

• Contract Management: Initiate, coordinate, and own the contracting activities to fulfillment, including receipt and processing of contracts and documentation. Conduct pre- and post-signature review of contracts and language modifications according to established policies.

•  Auditing and Loading: Responsible for auditing, building, and loading contracts, agreements, amendments, and fee schedules in contract management systems per established policies. This will include multiple systems, primarily SCM.

• Research and Analysis: Conduct research, analysis, and audits to identify issues and propose solutions to protect data, contract integrity, and performance.

• Contract Performance Management: Manage contract performance and support the development and implementation of value-based contract relationships in alignment with business strategies

• Cross-Functional Collaboration: Collaborate cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and review and analysis of reports as part of negotiation and reimbursement modeling activities. Assist with strategy development and facilitate activities as required to assist contingent worker activities.

• Subject Matter Expertise: Provide expert support for questions related to recruitment initiatives, contracting, provider issues/resolutions, related systems, and information contained. Share expertise and guidance with team members.

• Value-Based Contracting: Understand and manage value-based contracting and negotiations, as warranted.

• Project Management: Manage high-level projects and initiatives with inter-departmental resources and cross-functional stakeholders.

• Provider Meetings: Coordinate and participate in provider-facing meetings, including but not limited to Joint Operating Committee meetings, if warranted.

• Operational Support: Assist with operational activities such as database management and contract coordination.

• Data Management: Organize and transform information into comprehensible structures. Use data to predict trends in the customer base and the consumer population. Perform statistical analysis of data and visualize data in easy-to-understand formats, such as diagrams and graphs. Prepare reports and present findings to leadership.

• Provider Engagement: Engage with providers and efficiently move them through contracting processes in order to maintain robust network adequacy requirements. 

Required Qualifications

• Minimum 5 years related experience and comprehensive level of negotiating managed care contracts with individuals, complex provider systems, etc.

• Proven working knowledge of healthcare related provider financial issues and competitor strategies, large/complex contracting options, financial/contracting arrangements, and regulatory requirements

• Strong skills focused on communication, negotiations, critical thinking, problem resolution, competitor strategies

• Highly effective in WAH environment and proficient with MS Office (experienced with pivot tables, v-lookup, etc)

Preferred Qualifications

•  Solid decision-making skills while executing