Job Description
Job Description
CVS Health is on a mission to improve the health and mental wellbeing of the people in our communities. Looking to be on the forefront of healthcare, technology, and innovation? Aetnas Mental Wellbeing organization delivers and manages impactful products and programs that expand convenient access to high-quality and accordable mental and behavioral health services that support all people across all stages of everyday life.
Position Overview
This position assesses overall network composition and potential provider partners in order to identify and service partnerships that will advance and differentiate the Behavioral Health and EAP Network. This role negotiates, executes, and services contracts with local market providers in accordance with company standards to enhance provider networks and exceed accessibility, quality, and financial goals and cost initiatives.
Position Accountabilities
* Negotiates and executes, conducts high level review and analysis, dispute resolution and/or settlement negotiations of contracts with local market providers.
* Recruits providers and drives provider engagement as needed to ensure attainment of network expansion and adequacy targets.
* Manages contract performance and may support the development and implementation of value based contract relationships in support of business strategies.
* 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.
* Optimizes interaction with assigned providers and internal business partners to manage relationships to ensure provider needs are met.
* Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.
* 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.
* Serves as SME for less experienced team members and internal partners.
Required Qualifications
* Proven working knowledge of Behavioral Health provider operations, competitor strategies, financial/contracting arrangements, and regulatory requirements.
* 5-7 years related experience and comprehensive level of influencing skills with successful track record negotiating and servicing contracts with individual or complex provider systems or groups, preferably in Behavioral Health.
* Experience in designing and negotiating value based contracts and alternative payment models preferred.
* Strong communication, critical thinking, problem resolution and interpersonal skills.
Preferred Qualifications
N/A
Education
Bachelors Degree or equivalent combination of education and experience.
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
CVS Health is on a mission to improve the health and mental wellbeing of the people in our communities. Looking to be on the forefront of healthcare, technology, and innovation? Aetnas Mental Wellbeing organization delivers and manages impactful products and programs that expand convenient access to high-quality and accordable mental and behavioral health services that support all people across all stages of everyday life.
Position Overview
This position assesses overall network composition and potential provider partners in order to identify and service partnerships that will advance and differentiate the Behavioral Health and EAP Network. This role negotiates, executes, and services contracts with local market providers in accordance with company standards to enhance provider networks and exceed accessibility, quality, and financial goals and cost initiatives.
Position Accountabilities
* Negotiates and executes, conducts high level review and analysis, dispute resolution and/or settlement negotiations of contracts with local market providers.
* Recruits providers and drives provider engagement as needed to ensure attainment of network expansion and adequacy targets.
* Manages contract performance and may support the development and implementation of value based contract relationships in support of business strategies.
* 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.
* Optimizes interaction with assigned providers and internal business partners to manage relationships to ensure provider needs are met.
* Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.
* 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.
* Serves as SME for less experienced team members and internal partners.
Required Qualifications
* Proven working knowledge of Behavioral Health provider operations, competitor strategies, financial/contracting arrangements, and regulatory requirements.
* 5-7 years related experience and comprehensive level of influencing skills with successful track record negotiating and servicing contracts with individual or complex provider systems or groups, preferably in Behavioral Health.
* Experience in designing and negotiating value based contracts and alternative payment models preferred.
* Strong communication, critical thinking, problem resolution and interpersonal skills.
Preferred Qualifications
N/A
Education
Bachelors Degree or equivalent combination of education and experience.
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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