Senior Manager, Network Manager (IC), Texas Medicaid Aetna Better Health

at  CVS Health

Bring 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.

POSITION SUMMARY

In this Texas Medicaid individual contributor role the Network Management Senior Manager will negotiate, execute, and conduct high level review and rate analysis, dispute resolution and/or settlement negotiations of contracts with larger and more complex, regional based hospital systems, large physician groups, and ancillaries in accordance with company standards.

• Recruit, negotiate and execute Aetna Better Health provider contracts, conduct high level review and analysis, dispute resolution and/or settlement negotiations of contracts with larger and more complex, market-based, hospitals, health systems group/system providers.
• Recruit providers as needed to ensure attainment of network expansion and adequacy targets.
• Responsible for identifying and managing cost issues and initiating appropriate cost saving initiatives and/or settlement activities.
• Represents company with high visibility constituents, including customers and community groups. Promotes collaboration with internal partners.
• Optimize interaction with assigned providers and internal business partners to facilitate relationships and ensure provider needs are met.
• Participates in JOC meetings.
• Manages complex, contractual relationships with providers according to prescribed guidelines in support of national and regional network strategies.
• Manages contract performance and supports the development and implementation of value-based contract relationships in support of business strategies.
• Accountable for cost arrangements within defined groups.
• Collaborates cross-functionally to manage Hospital, Ancillary and 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
• 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.
• Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.

REQUIRED QUALIFICATIONS

Critical thinking to maintain cost management and a fully engaged network of participating hospitals, ancillaries and providers.
5-7 years related experience and comprehensive level of negotiating skills with successful track record negotiating contracts with complex provider systems or groups.
3+ years of related experience at an Expert level negotiation skills with successful track record negotiating contracts with large or complex health systems
Microsoft Office/Excel proficient
Ability to travel in assigned market up to 15% of the time as needed.
Resident of Texas

PREFERRED QUALIFICATIONS

Healthcare Industry experience with either a payer or provider
Strong communication, critical thinking, problem resolution and interpersonal skills.
Knowledge of Texas Medicaid provider and payer landscape is a plus.
Understanding knowledge of Value Based Contracting
Internal Aetna system knowledge a plus
Proven working knowledge of provider financial issues and competitor strategies, complex contracting options, financial/contracting arrangements and regulatory requirements.

EDUCATION

Bachelor’s Degree or equivalent combination of education and experience.

• Recruit, negotiate and execute Aetna Better Health provider contracts, conduct high level review and analysis, dispute resolution and/or settlement negotiations of contracts with larger and more complex, market-based, hospitals, health systems group/system providers.
• Recruit providers as needed to ensure attainment of network expansion and adequacy targets.
• Responsible for identifying and managing cost issues and initiating appropriate cost saving initiatives and/or settlement activities.
• Represents company with high visibility constituents, including customers and community groups. Promotes collaboration with internal partners.
• Optimize interaction with assigned providers and internal business partners to facilitate relationships and ensure provider needs are met.
• Participates in JOC meetings.
• Manages complex, contractual relationships with providers according to prescribed guidelines in support of national and regional network strategies.
• Manages contract performance and supports the development and implementation of value-based contract relationships in support of business strategies.
• Accountable for cost arrangements within defined groups.
• Collaborates cross-functionally to manage Hospital, Ancillary and 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
• 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.
• Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information