Provider Network Management and Development, SR Mgr ...

Job DescriptionManage the development of contracts and agreements with providers and delivery systems in conjunction with being accountable for designing conceptual models, initiative planning, and negotiating high value/risk contracts with the most complex and challenging, market/region/national, largest group/system or highest value/volume of spend providers in accordance with company standards in order to maintain and enhance provider networks, while working cross functionally to ensure consistency with all contracting strategies and meeting and exceeding accessibility, quality, compliance, and financial goals and cost initiativesRoles & Responsibilities but not limited to: Negotiates and executes, conducts high level review and analysis, dispute resolution and/or settlement negotiations of contracts with larger and more complex, market-based, group/system providersResponsible for contract performance (aggressively manage contract operating costs, optimize performance of quality and productivity) and supports the development and implementation of value-based contract relationships in support of business strategiesRecruits providers as needed to ensure attainment of network expansion and adequacy targetsAccountable for actively managing financial cost performance using key business indicators, metrics and analysis/planning toolsCollaborates 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 activitiesResponsible for identifying and managing cost issues and initiating appropriate cost saving initiatives and/or settlement activitiesAssists with the design, development, management, and or implementation of strategic network configurations and integration activitiesDrives or 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 implicationsAccountable for cost arrangements within defined groupsResponsible for identifying and managing cost issues and collaborating cross functionally to execute significant cost saving initiativesRepresents company with high visibility constituents, including customers and community groupsPromotes collaboration with internal partnersEvaluates, helps formulate, and implements the provider network strategic plans to achieve contracting targets and manage medical costs through effective provider contracting to meet state contract and product requirementsCollaborates with internal partners to assess effectiveness of tactical plan in managing costsMay optimize interaction with assigned providers and internal business partners to facilitate relationships and ensure provider needs are metPay 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 QualificationsMinimum 5-7+ years related experience and expert level negotiation skills with successful track record negotiating contracts with large or complex provider systemsExperience with Medicaid Managed CareProven working knowledge of provider financial issues and competitor strategies, complex contracting options, financial/contracting arrangements and regulatory requirementsStrong communication, critical thinking, problem resolution and interpersonal skillsSome travel required to LouisianaPreferred QualificationsCandidates who reside in LouisianaKnowledge of Louisiana Medicaid and NetworksEducationBachelor's Degree or equivalent combination of education and experienceBusiness OverviewBring 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.

Created: 2025-11-15