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Job Description
Job Description
Develops networks, negotiates and executes contracts, conducts high level review and analysis, engages in dispute resolution and/or settlement negotiations of contracts with larger and more complex, market/regional/national based ancillary providers in accordance with company standards in order to maintain and enhance provider networks while meeting and exceeding accessibility, quality, and financial goals and cost initiatives. This includes (but is not limited to) delegated IPA and hospital contracts and the development of contracted ancillary and work on contracting strategies which will include ensuring the network is maintaining quality metrics. In addition, engagement and continuous collaboration with internal/external constituents for evolving ideas in supporting the California market.
This is a fulltime work at home position for anyone living within commuting distance to the San Diego office.
Required Qualifications
3-5 years contracting in a managed care or health plan setting
Solid understanding of healthcare payments methodologies including capitation, DRGs, per diem, case rates and value based agreements
Preferred Qualifications
medicaid health plan experience
#LI-JM1
Education
bachelor's degree or equivalent 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.
Develops networks, negotiates and executes contracts, conducts high level review and analysis, engages in dispute resolution and/or settlement negotiations of contracts with larger and more complex, market/regional/national based ancillary providers in accordance with company standards in order to maintain and enhance provider networks while meeting and exceeding accessibility, quality, and financial goals and cost initiatives. This includes (but is not limited to) delegated IPA and hospital contracts and the development of contracted ancillary and work on contracting strategies which will include ensuring the network is maintaining quality metrics. In addition, engagement and continuous collaboration with internal/external constituents for evolving ideas in supporting the California market.
This is a fulltime work at home position for anyone living within commuting distance to the San Diego office.
Required Qualifications
3-5 years contracting in a managed care or health plan setting
Solid understanding of healthcare payments methodologies including capitation, DRGs, per diem, case rates and value based agreements
Preferred Qualifications
medicaid health plan experience
#LI-JM1
Education
bachelor's degree or equivalent 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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