Sr Mgr,Network Mgt (IC)

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
?? 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 individual and group 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 owns 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 established policies.
?? 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 Expertise for questions related to recruitment initiatives, contracting, provider issues/resolutions, related systems and information contained.
?? Understanding of Value-Based contracting and negotiations.
?? Preparing reports and presenting to Network Management leadership
?? Engage with providers and move quickly through contracting processes to ensure network adequacy standards are met.

Required Qualifications
?? 3-5 years of network contracting/management experience.
?? 3-5 years of solid negotiating and complex decision-making skills while executing national, regional, or market level strategies.
?? In-depth knowledge of the managed care industry and practices.
?? Working knowledge of behavioral health topics related to managed care plans.
?? Detail-oriented with strong communication, analytical and negotiation skills.
?? Demonstrated high proficiency with MS Office suite applications (e.g., Outlook, Word, Excel, etc.)
?? Ability to build collaborative relationships with providers work cross-functionally to resolve complex provider contract issues.
?? Ability to work remotely, preferably in NY or NJ. Candidates in other east coast states will also be considered.

Preferred Qualifications
?? Health plan experience supporting behavioral health provider networks.
?? General knowledge of reporting tools for contract financial analysis and modeling.
?? Solid decision-making skills while executing national, regional and market level strategies.
?? Possess critical thinking, issue resolution and interpersonal skills.
?? Strong communication skills (written, verbal and presentation).
?? Highly organized and self-driven.

Education
?? Bachelor's degree or equivalent professional work experience.

Pay Range

The Typical Pay Range For This Role Is

$82,940.00 - $199,144.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company??s equity award program.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company??s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (??PTO??) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 04/21/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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