CVS Health Senior Manager, Provider Contracting (Medicaid) in Lawrence, Kansas
WFH Medicaid Senior Contracting RolePreferred Locations: Michigan, Illinois, KansasSummary: • Manage the development of contracts and agreements with providers and delivery systems in conjunction with being 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. Roles & Responsibilities: • Negotiates and executes, conducts high level review and analysis, dispute resolution and/or settlement negotiations of contracts with larger and more complex, market-based, group/system providers. • Responsible for contract performance (aggressively manage contract operating costs, optimize performance of quality and productivity) and supports 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 actively managing financial cost performance using key business indicators, metrics and analysis/planning tools. • 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 initiating appropriate cost saving initiatives and/or settlement activities.• Assists with the design, development, management, and or implementation of strategic network configurations and integration activities. • 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. • 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 to contract interpretation and parameters.• Interprets contractual requirements including federal and state regulations and NCQA. • Participates in JOC meetings.• Promotes and educate providers on cultural competency.• Sets specific, challenging and achievable objectives and action plans.• Manages complex, contractual relationships with providers according to prescribed guidelines in support of national and regional network strategies.• Mentor and coach new/more junior staff to educate and inform on accreditation and regulatory standards as well as policies on credentialing and re-credentialing.
The typical pay range for this role is:
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
• Experience with Medicaid Managed Care• Proven working knowledge of provider financial issues and competitor strategies, complex contracting options, financial/contracting arrangements and regulatory requirements• 7+ years related experience and expert level negotiation skills with successful track record negotiating contracts with large or complex provider systems• Strong communication, critical thinking, problem resolution and interpersonal skills
COVID-19 Vaccination Requirement
CVS Health requires certain colleagues 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, religious belief, or other legally recognized reasons that prevents them from being 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 or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
• Knowledge and experience with managed care landscape in Michigan, Illinois, Kansas
Bachelor’s Degree or equivalent combination of education and experience.
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