CVS Health
Senior Network Provider Manager, National Medicaid Ancillary Contracting
CVS Health, Austin, Texas, us, 78716
Overview
Senior Network Provider Manager, National Medicaid Ancillary Contracting (Remote). CVS Health is a leading health solutions company committed to transforming health care. Position Summary The Medicaid Senior Manager, Network Management: negotiates and analyzes dispute resolution and/or settlement negotiations of contracts with national providers (e.g., labs, Home Health, Home Infusion, Dialysis Centers, Transportation and Vision vendors) to maintain and enhance provider networks while meeting accessibility, quality and financial goals and cost initiatives. Responsible for provider recruitment to achieve network expansion targets and regulatory/internal adequacy. Supports expansion initiatives and contracting activities as needed. Owns contracting activities from receipt and processing of contracts through pre- and post-signature review and language modification per established policies. Audits, builds, and loads contracts, amendments and/or fee schedules in contract management systems per policies. Conducts research, analysis and audits to protect data, contract integrity and performance. Manages contract performance and supports value-based contract relationships in line with business strategies. Collaborates cross-functionally on provider compensation and pricing development, submission of contractual information, and review/analysis of reports as part of negotiation and reimbursement modeling. Provides SME support for recruitment, contracting, provider issues/resolutions, and related systems/information. Provides guidance to team members. Understands value-based contracting and negotiations. Manages high-level projects and recruitment initiatives with interdepartmental resources and cross-functional stakeholders. May participate in JOC meetings. Supports operational activities such as database management and contract coordination. Organizes information into comprehensible structures. Uses data to predict trends and performs statistical analysis and data visualization. Prepares and presents reports to leadership. Engages with providers to move contracting processes to meet network adequacy requirements. Location : This position can sit anywhere in the United States. Responsibilities
Negotiate, execute, and conduct high-level reviews of disputes/settlements with national providers including labs, Home Health, Home Infusion, Dialysis Centers, Transportation and Vision vendors. Recruit providers to meet network expansion goals and adequacy targets. Support health plan expansion initiatives and contracting activities. Coordinate and own contracting activities, including receipt/processing of contracts and pre-/post-signature reviews and language modification per policies. Audit, build, and load contracts, amendments, and fee schedules in contract management systems per policies. Research, analyze, and audit to identify issues and propose solutions to protect data, contract integrity and performance. Manage contract performance and support value-based relationships. Collaborate cross-functionally on compensation, pricing development, and reimbursement modeling. Provide SME support for recruitment initiatives, contracting, provider issues/resolutions, and related systems. Share guidance and expertise with the team. Understand and apply value-based contracting and negotiations. Manage high-level projects and recruitment initiatives with interdepartmental resources and stakeholders. May participate in JOC meetings. Support operational activities such as database management and contract coordination. Organize information into comprehensible structures and use data to predict trends and perform analyses. Required Qualifications
5+ years of network contracting/management experience. Ability to travel as needed (up to 25%). 5 years of experience with standard provider contracts, terms and language. 5 years of proven negotiating and decision-making skills for national/regional/market strategies. In-depth knowledge of the managed care industry and competitor strategies, financial/contracting arrangements. Knowledge of ancillary contracting (DME, Lab, Infusion, Home Health, Urgent Care and Vendor). Proficiency with MS Office applications (Outlook, Word, Excel, etc.). Knowledge of Medicaid programs. Strong decision-making, relationship-building, critical thinking, problem resolution, and interpersonal skills. Ability to identify opportunities to support program delivery. Strong written, verbal, and presentation communication skills. Highly organized and self-driven. Preferred Qualifications
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 base pay range may vary based on experience, education, geography, and other factors. Eligible for CVS Health bonus, commission or short-term incentive, and equity award programs. Benefits
We offer a comprehensive and competitive mix of pay and benefits to support colleagues and their families, including: Affordable medical plan options, a 401(k) with company matching, and employee stock purchase plan. No-cost programs for wellness, counseling, financial coaching, and tobacco cessation/weight management. Solutions addressing diverse needs and preferences, including PTO, flexible schedules, family leave, dependent care resources, tuition assistance, preserve access and other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits Application window close date: 09/11/2025. Qualified applicants with arrest or conviction records will be considered in accordance with all applicable laws.
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Senior Network Provider Manager, National Medicaid Ancillary Contracting (Remote). CVS Health is a leading health solutions company committed to transforming health care. Position Summary The Medicaid Senior Manager, Network Management: negotiates and analyzes dispute resolution and/or settlement negotiations of contracts with national providers (e.g., labs, Home Health, Home Infusion, Dialysis Centers, Transportation and Vision vendors) to maintain and enhance provider networks while meeting accessibility, quality and financial goals and cost initiatives. Responsible for provider recruitment to achieve network expansion targets and regulatory/internal adequacy. Supports expansion initiatives and contracting activities as needed. Owns contracting activities from receipt and processing of contracts through pre- and post-signature review and language modification per established policies. Audits, builds, and loads contracts, amendments and/or fee schedules in contract management systems per policies. Conducts research, analysis and audits to protect data, contract integrity and performance. Manages contract performance and supports value-based contract relationships in line with business strategies. Collaborates cross-functionally on provider compensation and pricing development, submission of contractual information, and review/analysis of reports as part of negotiation and reimbursement modeling. Provides SME support for recruitment, contracting, provider issues/resolutions, and related systems/information. Provides guidance to team members. Understands value-based contracting and negotiations. Manages high-level projects and recruitment initiatives with interdepartmental resources and cross-functional stakeholders. May participate in JOC meetings. Supports operational activities such as database management and contract coordination. Organizes information into comprehensible structures. Uses data to predict trends and performs statistical analysis and data visualization. Prepares and presents reports to leadership. Engages with providers to move contracting processes to meet network adequacy requirements. Location : This position can sit anywhere in the United States. Responsibilities
Negotiate, execute, and conduct high-level reviews of disputes/settlements with national providers including labs, Home Health, Home Infusion, Dialysis Centers, Transportation and Vision vendors. Recruit providers to meet network expansion goals and adequacy targets. Support health plan expansion initiatives and contracting activities. Coordinate and own contracting activities, including receipt/processing of contracts and pre-/post-signature reviews and language modification per policies. Audit, build, and load contracts, amendments, and fee schedules in contract management systems per policies. Research, analyze, and audit to identify issues and propose solutions to protect data, contract integrity and performance. Manage contract performance and support value-based relationships. Collaborate cross-functionally on compensation, pricing development, and reimbursement modeling. Provide SME support for recruitment initiatives, contracting, provider issues/resolutions, and related systems. Share guidance and expertise with the team. Understand and apply value-based contracting and negotiations. Manage high-level projects and recruitment initiatives with interdepartmental resources and stakeholders. May participate in JOC meetings. Support operational activities such as database management and contract coordination. Organize information into comprehensible structures and use data to predict trends and perform analyses. Required Qualifications
5+ years of network contracting/management experience. Ability to travel as needed (up to 25%). 5 years of experience with standard provider contracts, terms and language. 5 years of proven negotiating and decision-making skills for national/regional/market strategies. In-depth knowledge of the managed care industry and competitor strategies, financial/contracting arrangements. Knowledge of ancillary contracting (DME, Lab, Infusion, Home Health, Urgent Care and Vendor). Proficiency with MS Office applications (Outlook, Word, Excel, etc.). Knowledge of Medicaid programs. Strong decision-making, relationship-building, critical thinking, problem resolution, and interpersonal skills. Ability to identify opportunities to support program delivery. Strong written, verbal, and presentation communication skills. Highly organized and self-driven. Preferred Qualifications
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 base pay range may vary based on experience, education, geography, and other factors. Eligible for CVS Health bonus, commission or short-term incentive, and equity award programs. Benefits
We offer a comprehensive and competitive mix of pay and benefits to support colleagues and their families, including: Affordable medical plan options, a 401(k) with company matching, and employee stock purchase plan. No-cost programs for wellness, counseling, financial coaching, and tobacco cessation/weight management. Solutions addressing diverse needs and preferences, including PTO, flexible schedules, family leave, dependent care resources, tuition assistance, preserve access and other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits Application window close date: 09/11/2025. Qualified applicants with arrest or conviction records will be considered in accordance with all applicable laws.
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