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CVS Health Network Manager and Provider Contracting in Chicago, Illinois

Job Description

Negotiates, executes, conducts high level review and analysis, dispute resolution and/or settlement negotiations of contracts with larger and more complex, market/regional/national based group/system providers 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.

Fundamental Components

Negotiates and executes, conducts high level review and analysis, dispute resolution and/or settlement negotiations of contracts with larger and more complex, market-based, group/system providers. Manages contract performance and supports the development and implementation of value based contract 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. 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. Responsible for identifying and managing cost issues and initiating appropriate cost saving initiatives and/or settlement activities. Serves as SME for less experienced team members and internal partners. Provides network development, maintenance, and refinement activities and strategies in support of cross-market network management unit. Assists with the design, development, management, and or implementation of strategic network configurations and integration activities. May optimize interaction with assigned providers and internal business partners to manage relationships to 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.

Background Experience

Proven working knowledge of provider financial issues and competitor strategies, complex contracting options, financial/contracting arrangements and regulatory requirements. 5-7 years related experience and comprehensive level of negotiating skills with successful track record negotiating contracts with individual or complex provider systems or groups. Medicaid experience a plus. Knowledge of government requirements is required. Strong communication, critical thinking, problem resolution and interpersonal skills. Bachelor’s Degree or equivalent combination of education and experience.

Education

Bachelor's degree or equivalent experience

Percent of Travel Required

25 - 50%

Business Overview

Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

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