Senior Manager, Network Manager (IC), Texas Medicaid VBC

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Position Summary

In this Texas Medicaid individual contributor role the Network Management Senior Manager will negotiate, execute, and conduct high level review and rate analysis, dispute resolution and / or settlement negotiations of contracts with larger and more complex, regional based hospital systems, large physician groups, and ancillaries in accordance with company standards;

with emphasis on value based agreements.

• Recruit, negotiate and execute Aetna Better Health value based provider contracts, conduct high level review and analysis, dispute resolution and / or settlement negotiations of contracts with larger and more complex, market-based, hospitals, health systems group / system providers.
• Recruit providers as needed to ensure attainment of network expansion and adequacy targets.
• Responsible for identifying and managing cost issues and initiating appropriate cost saving initiatives and / or settlement 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.
• Participates in 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.
• Responsible for collaborating with value based providers and managing risk agreements to include coordinating responses to processes including capitation, eligibility, delegation and claims and member services.
• Accountable for cost arrangements within defined groups.
• Collaborates cross-functionally to manage Hospital, Ancillary and 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
• Serves as SME for less experienced team members and internal partners.
• Provides network development, maintenance, and refinement activities and strategies in support of cross market network management unit.
• Assists with the design, development, management, and or implementation of strategic network configurations and integration activities.
• 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

Critical thinking to maintain cost management and a fully engaged network of participating hospitals, ancillaries and providers.

5-7 years related experience and comprehensive level of negotiating skills with successful track record negotiating contracts with complex provider systems or groups.

3+ years of related experience at an Expert level negotiation skills with successful track record negotiating contracts with large or complex health systems

Microsoft Office / Excel proficient

Ability to travel in assigned market up to 15% of the time as needed.

Resident of Texas

Preferred Qualifications

Healthcare Industry experience with either a payer or provider

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

Knowledge of Texas Medicaid provider and payer landscape is a plus.

Understanding knowledge of Value Based Contracting

Internal Aetna system knowledge a plus

Proven working knowledge of provider financial issues and competitor strategies, complex contracting options, value based agreements, financial / contracting arrangements and regulatory requirements.

Education

Bachelor’s Degree or equivalent combination of education and experience.

Pay Range

The typical pay range for this role is :

$75,400.00 - $166,000.00

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.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.

The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.

The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits.

CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.

As for time off, Company employees enjoy Paid Time Off ( PTO ) or vacation pay, as well as paid holidays throughout the calendar year.

Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.