Missouri Staffing
Senior Manager, Network Management, National Behavioral Health
Missouri Staffing, Jefferson City, Missouri, United States, 65109
Network Management Senior Manager
At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. Join Aetna/CVS Health, a Fortune 4 company, as the Network Management Senior Manager. In this role, you will manage negotiations, conduct high-level reviews and analysis, and manage dispute resolution and settlement negotiations of contracts with large and complex, national, and market-based, behavioral health groups and facility providers. You will manage contract performance and support the development and implementation of strategic, traditional contracts and value-based relationships. Key deliverables in this role include: Recruit large scale and/or innovative providers as needed to ensure attainment of network expansion and strategic targets. Collaborate 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. Responsible for identifying and managing cost issues and initiating appropriate cost saving initiatives and settlement activities. Assist with the design, development, management, and or implementation of strategic network configurations and integration activities. Manage contract performance and drive the development and implementation of value-based contract relationships in support of business strategies. Represent Aetna with high visibility constituents, including customers and community groups. Promote collaboration with internal partners. Evaluate, formulate, and implement the provider network strategic plan to achieve contracting targets and manage medical costs through effective provider contracting. Optimize interaction with assigned providers and internal business partners to facilitate relationships and ensure provider needs are met. To be successful, you will utilize your strong communication, critical thinking, problem resolution and interpersonal skills. Additional skills include: Adept at execution and delivery (planning, delivering, and supporting) skills Adept at business intelligence Adept presentation skills Adept at collaboration and teamwork Adept at growth mindset (agility and developing yourself and others) skills Required qualifications include: Commercial, Medicare, and/or Medicaid knowledge 5+ years related experience, proven and proficient managed care network negotiating skills. 3+ years contracting for large facilities or provider groups. Proven working knowledge of competitor strategies, complex contracting options, financial/contracting arrangements, and regulatory requirements. Preferred qualifications include: Proven working knowledge of value based (VBC) and Pay for Performance (P4P) behavioral health contracting solutions. Experience with behavioral health Institutes of Quality (IOQ). Well versed with the behavioral health provider national market. Education: Bachelor's degree preferred/specialized training/relevant professional qualification. Pay Range: $67,900.00 - $199,144.00 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 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
At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. Join Aetna/CVS Health, a Fortune 4 company, as the Network Management Senior Manager. In this role, you will manage negotiations, conduct high-level reviews and analysis, and manage dispute resolution and settlement negotiations of contracts with large and complex, national, and market-based, behavioral health groups and facility providers. You will manage contract performance and support the development and implementation of strategic, traditional contracts and value-based relationships. Key deliverables in this role include: Recruit large scale and/or innovative providers as needed to ensure attainment of network expansion and strategic targets. Collaborate 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. Responsible for identifying and managing cost issues and initiating appropriate cost saving initiatives and settlement activities. Assist with the design, development, management, and or implementation of strategic network configurations and integration activities. Manage contract performance and drive the development and implementation of value-based contract relationships in support of business strategies. Represent Aetna with high visibility constituents, including customers and community groups. Promote collaboration with internal partners. Evaluate, formulate, and implement the provider network strategic plan to achieve contracting targets and manage medical costs through effective provider contracting. Optimize interaction with assigned providers and internal business partners to facilitate relationships and ensure provider needs are met. To be successful, you will utilize your strong communication, critical thinking, problem resolution and interpersonal skills. Additional skills include: Adept at execution and delivery (planning, delivering, and supporting) skills Adept at business intelligence Adept presentation skills Adept at collaboration and teamwork Adept at growth mindset (agility and developing yourself and others) skills Required qualifications include: Commercial, Medicare, and/or Medicaid knowledge 5+ years related experience, proven and proficient managed care network negotiating skills. 3+ years contracting for large facilities or provider groups. Proven working knowledge of competitor strategies, complex contracting options, financial/contracting arrangements, and regulatory requirements. Preferred qualifications include: Proven working knowledge of value based (VBC) and Pay for Performance (P4P) behavioral health contracting solutions. Experience with behavioral health Institutes of Quality (IOQ). Well versed with the behavioral health provider national market. Education: Bachelor's degree preferred/specialized training/relevant professional qualification. Pay Range: $67,900.00 - $199,144.00 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 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