Network Manager (Provider Contracting) - Military Veterans

Job Description
Negotiates competitive and complex contracts with health care providers using pre-determined internal guidelines and financial standards. Negotiates contract language in accordance with Aetna standards, engaging other departments as needed for review and approval of contract terms outside the standards. Conducts competitive and financial analyses to achieve best in market discounts and financial results that are within pre-determined targets. Manages contract performance and works with various internal departments to address questions, issues, and activities related to execution, loading, and ongoing maintenance of provider contracts. Supports the development and implementation of value-based contract relationships in support of business strategies. Manages relationships with key providers and ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information. Negotiates settlements as needed. May recruit providers as needed to ensure network adequacy and achievement of network expansion goals. Maintains accountability for specific medical cost initiatives. Serves as SME for less experienced team members and internal partners.

Required Qualifications
***Post COVID Travel Restriction: Must be Willing to Travel via automobile to assigned provider meetings within Illinois and Contiguous States.***

5+ years of Negotiation of Hospital/Physician agreement experience, including IPA, PHO and other large provider groups,

Knowledge of contract language, ability to develop and analyze rate proposals, identifying operational and financial improvement opportunities.

Understanding of the value for utilizing competitive and financial data to negotiate favorable contracts

Thorough knowledge of complex contracting options, including APM & VBC arrangements.

Strong critical thinking, problem resolution, organization, communication and interpersonal skills.

Ability to successfully manage multiple negotiations, open issues and other tasks to ensure completion and meet deadlines.

Able to manage expectations and maintain strong relationship with external and internal partners

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
Medicaid and/or Medicare Contracting Experience

Familiarity with healthcare regulations/laws

Education
Bachelor's degree or equivalent work 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. See Job Description