CVS Health Job - 40308119 | CareerArc
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Company: CVS Health
Location: Philadelphia, PA
Career Level: Director
Industries: Retail, Wholesale, Apparel

Description

Job Description
Leads and manages teams of employees who develop,
negotiate, contract, and enhance provider networks of high quality, are cost efficient and will improve healthcare for our customers. Oversees the development of programs to maintain and enhance collaborative provider relationships and operational effectiveness. Maintains accountability for related compliance, quality and financial goals. Manages a high functioning team responsible for
ensuring overall network competitiveness and profitability
for a given geographical area or assigned provider type.
The Director's responsibility and complexity may vary by
market size and the need for units may be organized
around services such as hospitals, providers, providers, or
both; the type of contract, such as fee for service or value
based, compliance functions and or cost management
efforts.

Required Qualifications
-Leads a team of Network Managers, Consultants and
Contract Negotiators who design, develop, manage and/or
implement strategic network configurations and effective
managed care network relationships.
-Manages the activities of the network development team,
including effective strategies to build progressive provider
partners and relationships.
-Effectively negotiates the most complex, competitive
contractual relationships with providers according to
prescribed financial guidelines with all provider types
including at risk, IPA/IPO, hospital and large
provider/provider groups.
-Ensures necessary review; oversee and support network
filings in compliance with state and federal regulations.
-May include value-based agreements depending on
market requirements.
-Accountable for cost arrangements and contract
performance in support of network quality, availability and
financial strategies to achieve P-Model, discounts and cost
management goals.
-Ensures network coverage adequacy and implements
action items to close gaps.
-Responsible for advancing the adoption of value-based
payment models.
-Work with VBC Engagement managers to develop VBC
arrangements and collaborative agreements.
-Develops and presents value proposition; presents the
potential for network performance results in sales meetings or to external constituents.
-Analyzes data and is responsible for understanding
medical cost issues and trends; collaborates with Medical
Economics to monitor and identify scorable action plans;
works closely with Population Health to enable and
improve clinical outcomes.
-May oversee Network Relations teams that manage the
service needs for providers including network/provider
relations policy, recruitment, education and training, as well as improved workflows.
-Required to communicate w/internal/external parties by
phone/in person; may require travel to offsite location.

Preferred Qualifications
-8 – 10 years related experience Related experience in
health operations, network relations and development,
command of financials and pricing strategies, and sales
interface.
-Experience building and maintaining relationships with
provider systems
-A successful track record managing and negotiating major provider contracts
-In depth knowledge of various reimbursement structures
and payment methodologies for both hospitals and
providers/providers
-Knowledge and experience with value based contracting
and accountable care models
-In-depth knowledge of managed care business, regulatory/legal requirements
-Solid leadership skills, including staff development and
talent management

#LI-DI1

Education
Bachelors degree or equivalent work experience
MBA/Masters degree preferred

Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.


We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. 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.


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