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CVS Health Manager, Network Management (IC) - Remote Opportunity ! in Boston, Massachusetts

Job Description

•This position negotiates, executes, analyzes, and services contracts and/or handles dispute resolution and settlement negotiations with providers (i.e. local, individual providers, groups/systems) that will advance and differentiate the Behavioral Health and EAP Network in accordance with company standards in order to maintain and enhance provider networks and exceed accessibility, quality, and financial goals and cost initiatives. • • •Negotiates and executes, conducts high level review and analysis, dispute resolution and/or settlement negotiations of contracts with local market providers. • Recruits providers and drives provider engagement as needed to ensure attainment of network expansion and adequacy targets.• Manages contract performance and may support the development and implementation of value-based contract relationships in support of business strategies. • Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities. • Optimizes interaction with assigned providers and internal business partners to manage relationships to 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.• 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 and integration activities. • Serves as SME for less experienced team members and internal partners.

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

• Proven working knowledge of Behavioral Health provider operations, competitor strategies, financial/contracting arrangements, and regulatory requirements.• Strong communication, critical thinking, problem resolution and interpersonal skills.• 3-5 years related experience and comprehensive level of influencing skills with successful track record negotiating and servicing contracts with individual or small group providers, preferably in Behavioral Health.

Preferred Qualifications

• Proven working knowledge of Behavioral Health provider operations, competitor strategies, financial/contracting arrangements, and regulatory requirements.• Experience in designing and negotiating value-based contracts and alternative payment models preferred.

Education

Bachelors Degree or 3- 5 years of equivalent experience

Business Overview

Bring your heart to CVS Health Every 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 Behaviors™ 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. 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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