Senior Manager, Provider Plan Sponsor Consulting

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.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – 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
We are searching for an experienced provider network professional to support our plan sponsors in managing their provider network performance and strategies. This is an individual contributor role that will work as part of a cross functional team of clinicians and analysts that provide consultative information and create custom solutions for commercial Plan Sponsors.

The primary responsibilities of this position include identifying specific provider network strategies to manage medical cost and trend. This is a unique opportunity to work directly with plan sponsors, account management, local/ national network, clinicians and analysts to create customized network strategies for our plan sponsors.

The individual in this position will be responsible for creating strong relationships with local and national network teams, maintaining an in-depth knowledge of Aetna network strategies and performance and reviewing data to inform recommendations.

The successful candidate will serve as a subject matter expert on network related performance including contracting methodologies, network competitiveness and value-based designs. This is a customer facing position requiring the ability to communicate complex networking arrangements and delivery performance results to a wide variety of audiences. This position requires the ability to independently manage all network-related, customer- specific health plan performance and identify root causes, identify solutions and present meaningful analysis.

Required Qualifications

- Minimum of 7+ years of direct industry experience negotiating provider contracts and/or provider relations.

- Strong understanding of health care network product spectrum and contracting methodologies including advanced knowledge of value-based designs.

-Strong communication skills: Able to articulate (verbally and written) complex business results, issues and strategies in a clear, concise and confident manner to all levels and positions of an organization (internal and external).

- Must have strong knowledge of claim coding (CPT/DRG, etc.), provider networks, benefit designs, healthcare products/funding, medical management programs and financial acumen.

- Relationship management: Demonstrated relationship management skills at the senior level; capacity to quickly build and maintain credible relationships at varying levels of the organization simultaneously.

- Strategic Thinking: Must have demonstrated ability to think strategically in an independent manner and ‘out of the box’ versus accepting the status quo.

- Technical Skills: Must possess strong technical skills in Microsoft Office Applications (Excel, Word, PowerPoint) as well as experience using analytic/reporting applications
 

Preferred Qualifications
Familiarity with medical cost analytics and advanced technical skills
 

Education
Bachelors degree or equivalent experience

Pay Range

The typical pay range for this role is:

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 company’s 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 – 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 https://jobs.cvshealth.com/us/en/benefits

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.