Senior Manager, National Network Management (National Health Systems)

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

**Strong preference for candidate to sit in CA, GA, FL, TN, TX or VA**

In this individual contributor role, the Senior Manager, will manage the negotiation and development of contracts with the larger and more complex national or regional-based providers and health systems (hospitals, physician groups, and ancillaries). 

The Senior Manager will maintain accountability for designing conceptual models, initiative planning, and negotiating high value/risk contracts as well as conduct high-level review and analysis, dispute resolution and/or settlement negotiations of contracts with these groups in accordance with company standards.

Overall, this highly skilled individual will manage contract performance and support the development and implementation of strategic, maintain and enhance provider networks to meet accessibility, quality, financial goals, cost initiatives and value-based contract relationships.

• Negotiates and executes contracts, conducts high level review and analysis, participates in dispute resolution and/or settlement negotiations with larger and more complex health systems.
• Identifies and manages cost issues and commences appropriate cross-functional cost saving initiatives and/or settlement activities.
• 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.
• Represents company with high visibility constituents, including customers and community groups.
• Promotes collaboration with internal partners.
• Optimize interaction with assigned providers and internal business partners to facilitate relationships and ensure provider needs are met.
• Facilitates JOC meetings.
• Manages complex, contractual relationships with providers according to prescribed guidelines in support of national and regional network strategies.
• Manages contract performance and supports the development and implementation of value-based contract relationships in support of business strategies.
• Maintains accountability for cost arrangements within defined groups.
• Serves as SME for less experienced team members and internal partners.
• Ensures resolution of escalated issues related to, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.
• Evaluates, helps formulate, and implements national network strategic plans to achieve contracting targets and manage medical costs through effective contracting.
• Interprets contractual requirements including federal and state regulations and NCQA.

Required Qualifications

• A minimum of 7 years related experience and comprehensive level of negotiating skills with successful track record negotiating contracts with individual or complex provider systems or groups.
• A minimum of 5 years of successful expert-level negotiation experience negotiating contracts with large or complex health systems
• Critical thinking to maintain cost management and a fully engaged network of participating hospitals, ancillaries and providers.
• Healthcare industry experience with either a payer or provider

Preferred Qualifications

• Strong communication, critical thinking, problem resolution and interpersonal skills.
• Working knowledge of value-based contracting.·      
• Internal Aetna system knowledge
• Proven working knowledge of provider financial issues and competitor strategies, complex contracting options, financial/contracting arrangements and regulatory requirements.

Education

• Bachelors degree preferred or a combination of equivalent work experience and education.

Pay Range

The typical pay range for this role is:

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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

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