Senior Network Manager-Remote-KS,MO,CO,NE or OK

Job Description
•Accountable for designing conceptual models, initiative planning, and negotiating high value/risk contracts with the most complex and challenging, market/region/national, largest group/system or highest value/volume of spend providers in accordance with company standards in order to maintain and enhance provider networks, while working cross functionally to ensure consistency with all contracting strategies and meeting and exceeding accessibility, quality, compliance, and financial goals and cost initiatives.

•Drives or guides development of holistic solutions or strategic plans, negotiates and executes contracts with the most complex, market /region/national, largest group/system or highest value/volume of spend providers with significant financial implications.

•Manages contract performance and drives the development and implementation of value-based contract relationships in support of business strategies.

•Recruits providers as needed to ensure attainment of network expansion and adequacy targets.

•Accountable for cost arrangements within defined groups.

•Collaborates 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.

•Responsible for identifying and managing cost issues and collaborating cross functionally to execute significant cost saving initiatives.

•Represents company with high visibility constituents, including customers and community groups.

•Promotes collaboration with internal partners.

•Evaluates, helps formulate, and implements the provider network strategic plans to achieve contracting targets and manage medical costs through effective provider contracting to meet state contract and product requirements.

•Collaborates with internal partners to assess effectiveness of tactical plan in managing costs.

•May optimize interaction with assigned providers and internal business partners to facilitate relationships and ensure provider needs are met.

•Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.

Required Qualifications
This position can be located in the following states:
KS - WORK FROM HOME
MO - WORK FROM HOME
CO - WORK FROM HOME
OK - WORK FROM HOME
NE - WORK FROM HOME

•7+ years related experience and expert level negotiation skills with successful track record negotiating contracts with large or complex provider systems.

•Experience with Medicaid Managed Care

•10%-20% Travel

•Strong communication, critical thinking, problem resolution and interpersonal skills.

COVID Requirements
COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions 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, pregnancy, or religious belief that prevents them from being vaccinated.

• If you are 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 within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.

• If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.

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

•Knowledge of, and experience with value-based contracts and programs.

Education
Bachelor's Degree or equivalent combination of education and experience.

Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.