Senior Manager, Provider Network Management; Indiana

Contracting And Network Performance

Negotiates, executes, reviews, and analyzes contracts and/or handles dispute resolution and settlement negotiations

Manages contract performance

Contributes to provider compensation and pricing development activities and recommendations, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities.

May optimize interaction with assigned providers and internal business partners to manage relationships and ensure provider needs are met

Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information

Recruits providers as needed to ensure attainment of network expansion and adequacy targets

Responsible for identifying and making recommendations to manage cost issues and supporting cost saving initiatives and/or settlement activities

Assists with the design, development, management, and or implementation of strategic network configurations

Must reside in Indiana

5-7 years related experience and comprehensive level of negotiating with individual or complex provider systems or groups and/or completion of General Management Development Program (GMDP) with a combination of other relevant experience

Knowledge of Indiana provider systems and market landscape

Required to communicate w/internal/external parties by phone/in person; minimal travel to offsite provider groups and/or health system locations

Related experience in health operations, network relations and development, command of financials and pricing strategies, and sales interface

Experience building and maintaining relationships with provider systems

A successful track record managing and negotiating major provider contracts

In depth knowledge of various reimbursement structures and payment methodologies for both hospitals and providers

Knowledge and experience with value based contracting and accountable care models

In-depth knowledge of managed care business, regulatory / legal requirements

Medicare Advantage knowledge and experience

Bachelor's degree preferred/specialized training/relevant professional qualification

The typical pay range for this role is:

$67,900.00 - $

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.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.