Senior Network Provider Manager, National Medicaid Ancillary Contracting Remote

Position Summary

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

• Negotiates, executes, conducts high level review and analysis of dispute resolution and/or settlement negotiations of contracts with national providers including, but not limited to labs, Home Health, Home Infusion, Dialysis Centers, Transportation and Vision vendors, in accordance with company standards 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 owns 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.
• Provides guidance and shares expertise with others on the team.
• Understanding of value‑based contracting and negotiations.
• Manages high‑level projects and recruitment initiatives with interdepartmental resources and/or cross‑functional stakeholders.
• May participate in JOC meetings.
• Supports or assists with operational activities that may include, but are not limited to, database management and contract coordination.
• Organizes and transforms information into comprehensible structures.
• Uses data to predict trends in the customer base and the consumer population as a whole.
• Performs statistical analysis of data.
• Uses tools and techniques to visualize data in easy‑to‑understand formats, such as diagrams and graphs.
• Prepares reports and presents these to leadership.
• Engages with providers and quickly moves the providers through contracting processes in order to ensure meeting network adequacy requirements.

This position can sit anywhere in the United States.

• 5+ years of network contracting/management experience.
• Ability to travel as needed (up to 25% travel).
• 5 years of proven knowledge of standard provider contracts, terms and language.
• 5 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 competitor strategies, practices, and financial/contracting arrangements.
• Knowledge of ancillary contracting, i.e. DME, lab, infusion, home health, urgent care and vendor.
• Demonstrated high proficiency with personal computer, mouse, keyboard and all MS Office suite applications (e.g., Outlook, Word, Excel, etc.).
• Knowledge of Medicaid programs.
• Solid decision‑making skills while executing national, regional, and market level strategies.
• Ability to forge long‑lasting relationships.
• Possess critical thinking, problem‑resolution and…