Senior Network Provider Manager, National Medicaid Ancillary Contracting Remote

At CVS Health, weu2019re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nationu2019s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues u2013 caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position Summary The Medicaid Senior Manager, Network Management: u2219 Negotiates, executes, conducts high level review and analysis of dispute resolution and/or settlement negotiations of contracts with national providers including, but not limited to labs, Home Health, Home Infusion, Dialysis Centers, Transportation and Vision vendors, in accordance with company standards to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals and cost initiatives. u2219 Recruit providers as needed to ensure attainment of network expansion goals, achieve regulatory and/or internal adequacy targets. u2219 Support health plan with expansion initiatives or other contracting activities as needed. u2219 Initiates, coordinates and own the contracting activities to fulfillment including receipt and processing of contracts and documentation and pre- and post-signature review of contracts and language modification according to Aetnau2019s established policies. u2219 Responsible for auditing, building, and loading contracts, agreements, amendments and/or fee schedules in contract management systems per Aetnau2019s established policies. . u2219 Conducts research, analysis and/or audits to identify issues and propose solutions to protect data, contract integrity and performance. u2219 Manages contract performance and supports the development and implementation of value-based contract relationships in support of business strategies. u2219 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. u2219 Provides Subject Matter Expert support for questions related to recruitment initiatives, contracting, provider issues/resolutions, related systems and information contained. u2219 Provide guidance and share expertise to others on the team. u2219 Understanding of Value Based contracting and negotiations u2219 Manage high level projects and recruitment initiatives with interdepartmental resources and/or cross functional stakeholders. u2219 May participates in JOC meetings. u2219 Supports or assists with operational activities that may include, but are not limited to, database management and contract coordination. u2219 Organizing and transforming information into comprehensible structures. u2219 Using data to predict trends in the customer base and the consumer population as a whole u2219 Performing statistical analysis of data. u2219 Using tools and techniques to visualize data in easy-to-understand formats, such as diagrams and graphs. u2219 Preparing reports and presenting these to leadership. u2219 Engage with providers and quickly move the providers though contracting processes in order to ensure meeting network adequacy requirements. This position can sit anywhere in the United States. Required Qualifications u2219 5+ years of network contracting/management experience. u2219 Ability to travel as needed (up to 25% travel) u2219 5 years of proven knowledge of standard provider contracts, terms and language u2219 5 years of solid negotiating and decision-making skills while executing national, regional, or market level strategies. u2219 In-depth knowledge of the managed care industry and practices, as well as a strong understanding of competitor strategies, practices, and financial/contracting arrangements. u2219 Knowledge of ancillary contracting, i.e. DME, Lab, Infusion, Home Health, Urgent Care and Vendor u2219 Demonstrated high proficiency with personal computer, mouse, keyboard and all MS Office suite applications (e.g., Outlook, Word, Excel, etc.). - Knowledge of Medicaid programs. u2219 Solid decision-making skills while executing national, regional, and market level strategies. u2219 Ability to forge long-lasting relationship. u2219 Possess critical thinking, problem resolution and interpersonal skills. u2219 Ability to identify and capitalize on opportunities to support program delivery. u2219 Strong communication skills (written, verbal and presentation). u2219 Highly organized and self-driven. Preferred Qualifications u2219 Knowledge of Medicare and commercial programs and related subject matter. Education Bachelor's degree or equivalent professional work experience. Pay Range The typical pay range for this role is: $75,400.00 - $165,954.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the companyu2019s equity award program. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits u2013 investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: + Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan . + No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. + Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit We anticipate the application window for this opening will close on: 09/11/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.We are an equal opportunity and affirmative action employer. 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.