Senior Contract Manager, Network Management
Company: CVS Health
Location: San Antonio
Posted on: January 27, 2023
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Job Description:
Job DescriptionPosition Summary for the Senior Contract Manager,
Network Management role. Negotiates, executes, conducts high level
review and analysis of dispute resolution and/or settlement
negotiations of contracts with larger and more complex,
market/regional/national based group/system providers including but
not limited to large PCP groups, pediatricians, advanced specialist
groups, hospital based providers, ancillary providers, ambulatory
surgical centers, behavioral health providers, etc. 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. 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 own 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 Aetnas established policies.
Responsible for auditing, building, and loading contracts,
agreements, amendments and/or fee schedules in contract management
systems per Aetnas 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. Provide guidance and share
expertise to others on the team. Understanding of Value Based
contracting and negotiations Manage high level projects and
recruitment initiatives with interdepartmental resources and/or
cross functional stakeholders. May participates in JOC meetings.
Supports or assists with operational activities that may include,
but are not limited to, database management and contract
coordination. Organizing and transforming information into
comprehensible structures. Using data to predict trends in the
customer base and the consumer population as a whole Performing
statistical analysis of data. Using tools and techniques to
visualize data in easy-to-understand formats, such as diagrams and
graphs. Preparing reports and presenting these to leadership.
Engage with providers and quickly move the providers though
contracting processes in order to ensure meeting network adequacy
requirements.Pay RangeThe typical pay range for this role
is:Minimum: 75,400Maximum: 162,700Please keep in mind that this
range represents the pay range for all positions in the job grade
within which this position falls. The actual salary offer will take
into account a wide range of factors, including location.Required
Qualifications 7-10 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 desired. 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 Aetna competitor
strategies, practices, and financial/contracting arrangements.
Demonstrated high proficiency with personal computer, mouse,
keyboard and all MS Office suite applications (e.g., Outlook, Word,
Excel, etc.).Preferred Qualifications Knowledge of Medicaid
programs and related subject matter preferred. Solid
decision-making skills while executing national, regional, and
market level strategies. Ability to forge long-lasting
relationship. Possess critical thinking, problem resolution and
interpersonal skills. Ability to forge long-lasting relationship.
Must possess critical thinking, problem resolution and
interpersonal skills. Ability to identify and capitalize on
opportunities to support program delivery. Communication Skills -
Strong communication skills (written, verbal and presentation).
Ability to forge long-lasting relationships with providers. Highly
organized and self-driven.Education Bachelor's degree desired or
equivalent work experience.Business OverviewBring your heart to CVS
Health Every one of us at CVS Health shares a single, clear
purpose: Bringing our heart to every moment of your health. This
purpose guides our commitment to deliver enhanced human-centric
health care for a rapidly changing world. Anchored in our brand
with heart at its center our purpose sends a personal message that
how we deliver our services is just as important as what we
deliver. Our Heart At Work Behaviors support this purpose. We want
everyone who works at CVS Health to feel empowered by the role they
play in transforming our culture and accelerating our ability to
innovate and deliver solutions to make health care more personal,
convenient and affordable. We strive to promote and sustain a
culture of diversity, inclusion and belonging every day. CVS Health
is an affirmative action employer, and is an equal opportunity
employer, as are the physician-owned businesses for which CVS
Health provides management services. We do not discriminate in
recruiting, hiring, promotion, or any other personnel action based
on race, ethnicity, color, national origin, sex/gender, sexual
orientation, gender identity or expression, religion, age,
disability, protected veteran status, or any other characteristic
protected by applicable federal, state, or local law. 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.
Keywords: CVS Health, San Antonio , Senior Contract Manager, Network Management, Executive , San Antonio, Texas
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