Network Management Value Based Solutions (VBS), Senior ...

Job DescriptionThis role is fully remote - can sit anywhere in the US.This position requires technical and regulatory knowledge around Medicare risk deals as well as general working knowledge around value-based care. Proactively negotiates and manages complex provider agreements in accordance with company standards in order to maintain and enhance provider networks around value-based contracting, specifically Medicare risk arrangements. This position will be supporting: the development and execution of Medicare full risk programs, strategic relationships with provider networks as well as Management Services Organizations (MSOs), and execution of contracts with next generation primary care groups or organizations involved in Medicare risk-based arrangements. -Meets and exceeds accessibility, quality, performance and financial goals and cost initiatives. -Leads work and deliverables of multiple, complex projects/programs, through assessment to implementation, that impact multiple processes, systems, functions, and products across Medicare risk-based initiatives. -Negotiates contract deal terms, manages performance, and supports the development and implementation of value-based contract relationships, serving as SME in support of business strategies around Medicare risk contracts. -Develops relationships with providers and executes on go-to-market strategies and tactics around Medicare risk deals to ensure attainment of network expansion and adequacy targets. -Collaborates cross-functionally with various stakeholders internally and/or externally to scope/define projects, documentation of contractual information, and review/analysis of reports as part of Medicare risk arrangement activities. -Partners with other functional managers, business areas across/within segments to ensure all workflow processes and interdependencies are identified and addressed. -Identifies gaps and recommends any enhancements to processes and workflows based on relevant project needs. -Provides network development/expansion, provider relationships, and refinement activities in support of cross-market network management. -Assists with design, development, management, and/or implementation of strategic network configurations and integration activities as related to Medicare risk deals. -May optimize interaction with assigned providers and internal business partners/local contract managers to manage relationships to ensure provider eligibility, competency requirements, and needs are met. -Ensures resolution and documentation of escalated issues related, but not limited to, value-based contract deal terms, Medicare risk arrangement deal terms, etc. -Collaboratively works across multiple functions and /or segments to obtain agreement from all impacted parties (e.g., up and downstream effects often impact multiple functions and/or segments). -Cross function/segment group facilitation/presentation around Medicare-based programs. -Ensures timeliness of project and/or program management work including monitoring and tracking of progress and status update communications.-Ability to communicate effectively with all levels of management.-Proven ability to satisfy customers needs and develop alternatives to resolve issuesPay RangeThe typical pay range for this role is:Minimum: 75,400Maximum: 158,300Please 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-8+ years of payor or provider experience.-Proven project management skills.-Experience includes development and management of multiple priorities, leading multiple complex negotiations at a time-Proven track record in meeting project milestones and negotiating favorable termsCOVID RequirementsCOVID-19 Vaccination RequirementCVS 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-Extensive knowledge of MA to include risk coding, STARS measures, CMS bid strategy (inclusive of 3-5 years of value-based experience, preferred but not required).-8-10 years of Medicare Advantage, Managed Care Organization experience-Proven negotiation skills including extensive experience leading Medicare Advantage percent of premium/delegation dealsEducationBachelor's required or equivalent professional experience.Master's degree preferredBusiness OverviewBring 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 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.

Created: 2025-11-15