CVS Health

Hartford, Connecticut, United States

Senior Network Manager

Posted over 1 month ago

Job Description

Job Description
Dedicated day-to-day management focused on the development and performance of VBC Networks and complex products; responsible for the design, development, contracting, management of facilities, physicians and ancillary providers which serve as contractual networks of care for members.
Develop and manage the VBC strategy for the New England market in partnership with the CNO and Sales. Responsible for the contracting involving all VBC provider types and manages providers compensation and pricing development activities. Negotiates complex, competitive provider VBC contracts with significant financial implications and manages relationships with key strategic providers and health systems. Owns contractual relationships with VBC providers. Provide VBC network strategy support to Sales and Marketing along with assistance on community relations related items as necessary. Partner with Medical Economics team to assess effectiveness of tactical and strategic plans in managing medical costs. Oversees and supports applicable VBC network filings. Designs, develops, implements and manages network configurations for VBC providers while adhering to pre-determined internal guidelines and financial standards and targets. Accountable for VBC medical cost management for the market and responsible for understanding and managing medical cost issues and initiating appropriate action.

Required Qualifications
-8 - 10 years related experience in health operations, network relations and development, command of financials and pricing strategies, and sales interface.
-Experience building and maintaining relationships with provider systems.
-A successful track record managing and negotiating major provider contracts
-In-depth knowledge of various reimbursement structures and payment methodologies for both hospitals and providers.
-Knowledge and experience with value-based contracting and accountable care models
-In-depth knowledge of managed care business, regulatory /legal requirements.
-Solid leadership skills, including staff development and talent management.
-New England location preferred but will consider candidates in other locations.

Preferred Qualifications
-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.
-Manages contract performance, and drives 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 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, but
not limited to, claims payment, contract interpretation
and parameters, or accuracy of provider contract or
demographic information.

Education
Bachelor's degree or equivalent work experience MBA/Master's degree preferred.

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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