Senior Manager, Network Management

This is a fully remote position, open to applicants in New Mexico, +2 more states.

📋 Description

• Oversee comprehensive contract negotiations, execution, and analysis with hospitals, physician groups, and smaller/local health systems.

• Manage contract performance and create as well as implement value-based arrangements that align with the organizational strategy.

• Identify, recruit, and onboard providers to achieve network expansion and adequacy targets.

• Provide competitive and sustainable cost arrangements.

• Collaborate cross-functionally on provider compensation strategies, pricing development, and reimbursement modeling.

• Analyze financial and operational data to uncover cost-saving opportunities and implement initiatives with measurable outcomes.

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

• Assess and contribute to provider network strategies that comply 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.

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

• Work alongside Aetna and CVS departments to enhance physician performance and quality of care.

• Conduct high-level reviews and analyses, resolve disputes, and negotiate settlements for contracts.

⛳️ Requirements

• A minimum of 7 years of experience in negotiating contracts with hospitals, facilities, and physician groups, which includes developing contract language, analyzing rate proposals, and identifying opportunities for operational and financial improvement.

• At least 3 years of experience in provider relationship management or related healthcare roles, demonstrating proven expertise in contract management.

• Familiarity with provider financial issues and competitor strategies.

• Knowledge of large and complex contracting options, financial and contracting arrangements, as well as regulatory requirements.

• Capability to utilize competitive market data, financial metrics, and in-depth analysis to secure advantageous contract outcomes.

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

• A Bachelor’s degree is preferred or an equivalent combination of professional experience and education.

• Experience with commercial, individual exchange, and Medicare is preferred.

• Preferred experience in contracting with hospital systems and groups.

• Advanced proficiency in Excel, including pivot tables and VLOOKUP, is preferred.

• Strong preference for candidates residing in the Dallas-Fort Worth area or Oklahoma.

🏝️ Benefits

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

• Eligibility for an award target in the company’s equity award program.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources to support physical, emotional, and financial well-being.