CVS Health is a major healthcare organization that provides pharmacy services, health benefits, healthcare services, and related solutions. Its operations connect healthcare professionals, patients, pharmacies, and communities through a broad range of services.
CVS Health offers career opportunities in areas such as pharmacy, healthcare, nursing, customer service, technology, data analytics, administration, finance, retail operations, human resources, and management.
The company provides opportunities for candidates with different backgrounds and levels of experience. Job seekers can explore available positions and find roles that align with their qualifications, skills, and career goals.
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Manager, Network Management (National Health Systems)
Description
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.
Constructs negotiation, execution, review, and analysis of contracts. Delivers dispute resolution and settlement negotiations with providers. Ensures contract performance aligns with accessibility, compliance, quality, financial, and cost goals.
- Develop, maintain, and enhance working relationships with physicians/providers and local network and patient management teams in the markets with Aetna.
- Establishes and implements programs and innovative initiatives for the organization to advance Contract Negotiations initiatives.
- Forecasts changes within the Contract Negotiations industry, conducts business impact assessments, and develops modification strategies with the aid of process improvement methodologies.
- ntegrates cross-functional collaboration to contribute to provider compensation and pricing development activities and recommendations for negotiations and reimbursement modeling activities.
- Determines recommendations to manage cost issues and support cost-saving initiatives and settlement activities.
- Assists in the management of network development, maintenance, and refinement activities and strategies in support of cross-market network management units.
- Coaches more junior colleagues in techniques, processes, and responsibilities.
- Other duties and responsibilities as assigned by manager.
Required Qualifications
- 5+ years of provider contracting, claims management, or patient management experience.
- 5+ experience working with/or in a Claims environment
- 5+ experience that includes ACAS and HRP claim platforms, products, and benefits; patient management, provider relations, or claims management.
Preferred Qualification
- Experience with Aetna systems (SCM, Smart Front End, Rate Inquiry, Contract Inquiry)
Education
- Bachelor’s degree preferred or a combination of professional work experience and education.
Anticipated Weekly Hours
40
Time Type
Full time
