Senior Contract Manager, Network Management Medicaid (MI or IL)

Job Description

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.

Must reside in Michigan or Illinois

The Senior Contract Manager, Network Management 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/ health system providers including but not limited to large PCP groups, CIN, FQHC/RHC and independent physicians etc. in accordance with company standards 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.
• Initiate, coordinate, and own the contracting activities to fulfillment including receipt and processing of contracts, 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’s established policies.
• Conduct research, analysis and/or audits to identify issues and propose solutions to protect data, contract integrity and performance.
• Manage contract performance and support the development and implementation of value-based contract relationships in support of business strategies.
• Collaborate 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.
• Provide Subject Matter Expert support for questions related to recruitment initiatives, contracting, provider issues/resolutions, related systems and information contained.
• Provide guidance and share expertise to others on the team.
• Understanding of Value Based contracting and negotiations
• Manage high level projects and recruitment initiatives with interdepartmental resources and/or cross functional stakeholders.
• May participate in JOC meetings.
• Support or assist with operational activities that may include, but are not limited to, database management and contract coordination.
• Organize and transform information into comprehensible structures.
• Use data to predict trends in the customer base and the consumer population as a whole
• Perform statistical analysis of data.
• Use tools and techniques to visualize data in easy-to-understand formats, such as diagrams and graphs.
• Prepare reports and present these to leadership.
• Engage with providers and quickly move the providers though contracting processes to ensure meeting network adequacy requirements.
• Communication Skills – Strong communication skills (written, verbal and presentation)
• Highly organized and self-driven.

Required Qualifications

• Minimum 7+ years of network contracting/management experience.
• Ability to travel as needed (up to 40% travel). Minimum at least 1x month within Midwest Region
• Ability to forge long-lasting relationships with providers.
• Proven knowledge of complex provider contracts, terms, and language
• Solid negotiating and decision-making skills while executing national, regional, or market level strategies.
• In-depth knowledge of the managed care industry and practices, as well as a strong understanding of strategies, practices, and financial/contracting arrangements.
• Possess critical thinking, problem resolution and interpersonal skills.
• Ability to identify and capitalize on opportunities to support program delivery.
• Demonstrated high proficiency with personal computer, mouse, keyboard, and all MS Office suite applications (e.g., Outlook, Word, Excel, etc.).

Preferred Qualifications

• Knowledge of Medicaid programs and related subject matter.

Education

• Bachelor’s degree desired or equivalent relevant professional work experience.

Pay Range
The typical pay range for this role is: $75,400.00 – $162,700.00.

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.

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 jobs.CVSHealth.com/benefits

CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. 

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health colleagues can initiate a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through myHR (1-888-694-7287, or through myLeave at myHR). If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.