CVS Health · 4 hours ago
Senior Network Contracting, Medicaid (MI)
United States
Full-time
Remote
Mid, Senior Level
$75K/yr - $166K/yr
5+ years expCVS Health is dedicated to building a connected and compassionate health experience for individuals. The Senior Network Manager will negotiate contracts with complex healthcare providers, manage contract performance, and support the development of value-based relationships to enhance provider networks for 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
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)
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, a 401(k) plan (including matching company contributions), and an 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.
Company
CVS Health
CVS Health is a health solutions company that provides an integrated healthcare services to its members.
10001+ employees
Funding
Current Stage
Public CompanyTotal Funding
$4BKey Investors
Michigan Economic Development CorporationStarboard Value
2025-08-15Post Ipo Debt· $4B
2025-07-17Grant· $1.5M
2019-11-25Post Ipo Equity
Leadership Team
David Joyner
President and Chief Executive Officer, CVS Health
Chandra McMahon
SVP & CISO
Recent News
2026-01-25
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