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CVS Health · 2 days ago

Senior Network Contracting, Medicaid (MI)

Lansing, MI

Full-time

Hybrid

Senior Level

$75K/yr - $166K/yr

5+ years exp

CVS Health is the nation’s leading health solutions company, dedicated to transforming health care. The Senior Network Contracting role involves negotiating contracts with regional hospital systems and managing contract performance to support Medicaid products.

Health CareMedicalPharmaceuticalRetailSales

Responsibilities

Negotiate and execute 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

Qualification

Healthcare industry experienceValue Based ContractingNegotiation skillsMicrosoft Office/ExcelMedicaidProvider financial issues knowledgeProblem resolutionCritical thinkingInterpersonal skills

Required

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 10-15% of the time as needed (Michigan)

Bachelor's Degree or equivalent professional work experience

Preferred

Healthcare Industry experience with either a payer or provider

Strong communication, critical thinking, problem resolution and interpersonal skills

Understanding knowledge of Value Based Contracting

Internal Aetna system knowledge a plus

Understanding of Medicaid

Proven working knowledge of provider financial issues and competitor strategies, complex contracting options, financial/contracting arrangements and regulatory requirements

Benefits

Affordable medical plan options

401(k) plan (including matching company contributions)

Employee stock purchase plan

No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching

Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.