Manager, Network Management (National Health Systems

Constructs negotiation, execution, review, and analysis of contracts. Delivers dispute resolution and settlement negotiations with providers. Ensures contract performance aligns with accessibility, compliance, quality, financial, and cost goals.

• Develop, maintain, and enhance working relationships with physicians/providers and local network and patient management teams in the markets with Aetna.
• Establishes and implements programs and innovative initiatives for the organization to advance Contract Negotiations initiatives.
• Forecasts changes within the Contract Negotiations industry, conducts business impact assessments, and develops modification strategies with the aid of process improvement methodologies.
• ntegrates cross-functional collaboration to contribute to provider compensation and pricing development activities and recommendations for negotiations and reimbursement modeling activities.
• Determines recommendations to manage cost issues and support cost-saving initiatives and settlement activities.
• Assists in the management of network development, maintenance, and refinement activities and strategies in support of cross-market network management units.
• Coaches more junior colleagues in techniques, processes, and responsibilities.
• Other duties and responsibilities as assigned by manager.

• 5+ years of provider contracting, claims management, or patient management experience.
• 5+ experience working with/or in a Claims environment
• 5+ experience that includes ACAS and HRP claim platforms, products, and benefits; patient management, provider relations, or claims management.

Preferred Qualification

• Experience with Aetna systems (SCM, Smart Front End, Rate Inquiry, Contract Inquiry)

Education

• Bachelor’s degree preferred or a combination of professional work experience and education., Business impact analysis (BIA), Claims Management, Coaching, Contract Analysis, Contract Negotiation, Cost Control, Cross-Functional, Establish Priorities, Forecasting, Geography, Healthcare, Incentive Programs, Negotiation Skills, Network Administration/Management, Pricing, Process Improvement, Provider Contracting, Provider Relations, Reimbursement, Safety/Work Safety, Strategic Planning, User Interface/Experience (UI/UX)

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$54,300.00 - $159,120.00

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.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

CVS Health offers a world of promising job opportunities across a diverse range of careers in everything from corporate and pharmacy roles to retails positions. No matter where you work at CVS Health, your unique skills, talents and abilities are welcome and valued. We recognize and reward greatness and want our employees to know their work is making a difference in the lives of millions. Join us today. Together we can continue making innovative, high-quality health and pharmacy services safe, affordable and accessible - for all.

Company Size: 10,000 employees or more

Industry: Biotechnology/Pharmaceuticals