Senior Manager, Network Contracting

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Negotiate, execute, perform high-level reviews and analyses, and resolve disputes or conduct settlement discussions for contracts.

• Oversee larger and more intricate market, regional, and national provider groups and systems.

• Contract and implement fee-for-service and value-based agreements with physician groups, facilities, and ancillary providers.

• Collaborate with Aetna and CVS departments to enhance physician performance and quality of care.

• Recruit providers to meet network expansion and adequacy objectives.

• Manage cost arrangements within designated provider groups.

• Partner across functions on provider compensation, pricing development, contractual information submission, and reimbursement modeling.

• Lead comprehensive contract negotiations, execution, and analysis.

• Oversee contract performance and develop and implement value-based arrangements.

• Identify, recruit, and onboard providers.

• Analyze financial and operational data to uncover cost-saving opportunities and implement impactful initiatives.

• Represent the organization with providers, customers, and community stakeholders.

• Evaluate and contribute to provider network strategy in alignment with state requirements, product needs, and cost management goals.

• Enhance provider engagement and resolve complex escalations related to claims, contract interpretation, and provider data accuracy.

⛳️ Requirements

• 7+ years of experience in negotiating contracts with hospitals, facilities, and physician groups.

• Proficient in contract language development, rate proposal analysis, and identifying operational and financial improvement opportunities.

• Ability to utilize competitive market data, financial metrics, and detailed analysis to achieve favorable contract outcomes.

• 3+ years of experience in provider relationship management or similar healthcare roles.

• Demonstrated expertise in contract management.

• Knowledgeable about provider financial issues and competitor strategies.

• Familiarity with large/complex contracting options, financial arrangements, and regulatory requirements.

• Strong communication, critical thinking, problem-solving, and interpersonal skills.

• Candidates must reside in the state of Illinois.

• 10% travel is required.

• Advanced Excel skills, including proficiency in pivot tables and v-lookup functions.

• Experience in commercial, individual exchange, and Medicare contracting is preferred.

• Prior experience contracting with hospital systems and groups is preferred.

• A bachelor's degree is preferred or a combination of professional experience and education.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Comprehensive benefits package supporting physical, emotional, and financial well-being.

• CVS Health bonus, commission, or short-term incentive program.

• Award target in the company’s equity award program.