Senior Manager, National & Alternative Behavioral Network Management

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.

Do you want to make a large impact in your next role? Join Aetna/CVS Health, as the Network Management Senior Manager. In this role, you will manage contract performance and support the development and implementation of strategic and value-based relationships across national and innovative providers of behavioral healthcare. You will be asked to innovate on novel and industry leading value-based contracts, conduct high-level reviews and analysis, and manage dispute resolution and settlement negotiations of contracts, with large and complex, national, behavioral health groups and facility providers.

* Role is for national behavioral health contracting and strategic partnerships

• Guides development of holistic solutions and strategic plans by negotiating and executing contracts with the most complex, market /region/national, largest group/system or highest value/volume of spend providers with significant financial implications.

• Manages contract performance and drives the development and implementation of value-based relationships in support of business strategies.

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

• Accountable for cost arrangements within defined groups through collaborating 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.

• Responsible for identifying and managing cost issues and collaborating cross functionally to execute significant cost saving initiatives. Represents company with high visibility constituents, including customers and community groups. Promotes collaboration with internal partners.

• Evaluates, helps formulate, and implements the provider network strategic plans to achieve contracting targets and manage medical costs through effective provider contracting to meet state contract and product requirements.

• Collaborates with internal partners to assess effectiveness of tactical plan in managing costs. May optimize interaction with assigned providers and internal business partners to facilitate 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.

To be successful, you will utilize your strong communication, critical thinking, problem resolution and interpersonal skills.

• Adept at execution and delivery (planning, delivering, and supporting) skills
• Adept at business intelligence
• Adept presentation skills
• Adept at collaboration and teamwork
• Adept at growth mindset (agility and developing yourself and others) skills
• Adept at internal and external relationship management

• Expansive Commercial, Medicare, and/or Medicaid knowledge.
• Minimum of 5 years related experience, proven and proficient managed care network negotiating skills preferably with large facilities or provider groups
• Proven working knowledge of competitor strategies, complex contracting options, financial/contracting arrangements, and regulatory requirements

• Minimum 3+ years contracting for large facilities or provider groups
• Proven working knowledge of value based (VBC) and pay for performance (P4P) behavioral health contracting solutions
• Experience in evaluation of cost analysis, quality care, and health care outcomes reporting
• Experience with behavioral health Institutes of Quality (IOQ)
• Must be well versed with the virtual and national behavioral health provider market
• Familiar with…