Job Detail

Manager, Contract Negotiation (Medicaid) - CVS Health
Wichita, KS
Posted: Oct 02, 2022 05:41

Job Description

Job Description

Remote Position (Preferably candidate located in Michigan, Illinois, or Kansas)Summary- Serves as the subject matter expert in support of contracting initiatives and data audits to enhance provider networks while meeting and exceeding accessibility, compliance, quality, and financial goals. Responsible for reviewing, building and auditing complex contract and network data, support recruitment efforts, and collaborate on negotiations as needed.Role/Responsibilities- Negotiates, executes, reviews, and analyzes contracts and/or handles dispute resolution and settlement negotiations with solo, small group, or local providers, including SCAs, LOAs, and PPAs. - Manages contract performance in support of network quality, availability, and financial goals and strategies. - Recruits providers as needed to ensure attainment of network expansion and adequacy targets.- Collaborates cross-functionally to contribute to provider compensation and pricing development activities and recommendations, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities.- Responsible for identifying and making recommendations to manage cost issues and supporting cost saving initiatives and/or settlement activities.- 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, including integration activities.- May optimize interaction with assigned providers and internal business partners to manage 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.- Mentor and coach new/more junior staff to educate and inform on accreditation and regulatory standards as well as policies on credentialing and re-credentialing.- Interprets contractual requirements including federal and state regulations and NCQA. - Participates in JOC meetings.- Promotes and educate providers on cultural competency.

Pay Range

The typical pay range for this role is:

Minimum: 60,300

Maximum: 126,600

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications

- Reside in Michigan, Illinois, Kansas, or near bordering communities.- 3-5 years working knowledge of competitor strategies, complex contracting options, value-based contracting, financial/contracting arrangements and regulatory requirements- 3-5 years related experience, proven and proficient negotiating skills

COVID Requirements

COVID-19 Vaccination Requirement

CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

Preferred Qualifications

- Knowledge/experience with Medicaid contracting/provider network in Michigan, Illinois, and/or Kansas.- Strong communication, critical thinking, problem resolution and interpersonal skills

Education

- Bachelor's Degree or equivalent combination of education and experience

Business Overview

Bring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work BehaviorsTM support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.



Job Detail


Company Overview

CVS Health

Wichita, KS