Senior Manager, Contracting and Network Managem...
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.Position SummaryContracting
- Negotiates, executes, reviews, and analyzes contracts and/or handles dispute resolution and settlement negotiations focused on health systems in Indiana.
- Manages contract performance
- Contributes to provider compensation and pricing development activities and recommendations, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities.
- May optimize interaction with assigned providers and internal business partners to manage 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.
- Recruits’ providers as needed to ensure attainment of network expansion and adequacy targets.
- Responsible for identifying and making recommendations to manage cost issues and supporting cost saving initiatives and/or settlement activities.
- Assists with the design, development, management, and/or implementation of strategic network configurations
- Must reside in Indiana
- Minimum 7+ years related experience and comprehensive level of negotiating with individual or complex provider systems or groups.
- Knowledge of Indiana provider systems and market landscape.
- Required to communicate w/internal/external parties by phone/in person; minimal travel to offsite provider groups and/or health system locations
- Related experience in health operations, network relations and development, command of financials and pricing strategies, and sales interface.
- Experience building and maintaining relationships with provider systems.
- A successful track record managing and negotiating major provider contracts (move up)
- In depth knowledge of various reimbursement structures and payment methodologies for both hospitals and providers/providers.
- Knowledge and experience with value-based contracting and accountable care models.
- In-depth knowledge of managed care business, regulatory /legal requirements.
- Medicare Advantage knowledge and experience