Senior Network Provider Manager, CVS Health

CVS Health

Location:
United States, New York

Category:
Consulting

Contract Type:
Not provided

Salary:

82940.00 - 199144.00 USD / Year

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Job Description:

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Job Responsibility:

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
Collaborates cross-functionally to manage provider compensation and pricing development 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
Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information

Requirements:

Critical thinking to maintain cost management and a fully engaged network of participating hospitals, ancillaries and providers
A minimum of 5 years related experience and comprehensive level of negotiating skills with successful track record negotiating contracts with complex provider systems or groups
Understanding knowledge of Value Based Contracting
Microsoft Office/Excel proficient

Nice to have:

Healthcare Industry experience with either a payer or provider
Strong communication, critical thinking, problem resolution and interpersonal skills
Internal Aetna system knowledge a plus
Understanding of Medicare & Commercial
Proven working knowledge of provider financial issues and competitor strategies, complex contracting options, financial/contracting arrangements and regulatory requirements

What we offer:

Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
Benefit solutions including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access

Additional Information:

Job Posted:
May 17, 2025

Expiration:
May 24, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Senior Network Provider Manager