Sr Mgr,Network Mgt (IC)

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

• 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/system providers including but not limited to individual and group behavioral health providers, etc. in accordance with company standards in order 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
• Initiates, coordinates and owns contracting activities to fulfillment including receipt and processing of contracts and 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 established policies.
• 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.
• Provides Subject Matter Expertise for questions related to recruitment initiatives, contracting, provider issues/resolutions, related systems and information contained.
• Understanding of Value-Based contracting and negotiations.
• Preparing reports and presenting to Network Management leadership
• Engage with providers and move quickly through contracting processes to ensure network adequacy standards are met.

Required Qualifications

• 3-5 years of network contracting/management experience.
• 3-5 years of solid negotiating and complex decision-making skills while executing national, regional, or market level strategies.
• In-depth knowledge of the managed care industry and practices.
• Working knowledge of behavioral health topics related to managed care plans.
• Detail-oriented with strong communication, analytical and negotiation skills.
• Demonstrated high proficiency with MS Office suite applications (e.g., Outlook, Word, Excel, etc.)
• Ability to build collaborative relationships with providers work cross-functionally to resolve complex provider contract issues.
• Ability to work remotely, preferably in DC, MD and VA.   Candidates in other east coast states will also be considered.

Preferred Qualifications

• Health plan experience supporting behavioral health provider networks.
• General knowledge of reporting tools for contract financial analysis and modeling.
• Solid decision-making skills while executing national, regional and market level strategies.
• Possess critical thinking, issue resolution and interpersonal skills.
• Strong communication skills (written, verbal and presentation).
• Highly organized and self-driven.

Education

• Bachelor's degree or equivalent professional work experience.

Pay Range

The typical pay range for this role is:

$67,900.00 - $199,144.00

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.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.  This position also includes an award target in the company’s equity award program. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• 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.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 04/07/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.