[Remote] Senior Manager, Medicaid Network Management (Maryland) at CVS Health

Maitland, Florida, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

7+ years related experience and expert level negotiation skills with successful track record negotiating contracts with large or complex provider systems
Strong communication, critical thinking, problem resolution and interpersonal skills
Proven working knowledge of provider financial issues and competitor strategies, complex contracting options, financial/contracting arrangements and regulatory requirements
Medicaid Network Management experience, preferably Maryland Medicaid program
Residing within the state of Maryland highly preferred, will consider other locations within the DMV area
Bachelor’s Degree preferred or relevant professional experience

Responsibilities

Analyzes market needs and opportunities for network expansion, identifies gaps in the existing network, and proactively seeks new provider relationships to address those gaps
Ensures governance with healthcare regulations and contractual requirements, implementing strategies and processes to adhere to guidelines and requirements
Initiates moderate and/or complex contracting activities, including the collection of all required contract and credentialing documents, and obtains the necessary approval of non-standard rates and language modifications to contracts
Collaborates on negotiations or may handle contracting and re-contracting discussions with providers, provider groups and/or health systems
May participate in various internal and/or external meetings, serving as representative on behalf of the department
Supports or assists with operational activities that may include, but are not limited to, database management and contract coordination
Provides ongoing recommendations to leadership to guide decision-making and ensure alignment with the organization’s strategic goals
Coaches and mentors more junior level colleagues in contracting techniques, processes and responsibilities

Skills

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters

1963Year Founded

DEBTCompany Stage

Healthcare, Consumer GoodsIndustries

10,001+Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.

The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.

The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.

The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.

CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.

Increased consumer interest in wellness boosts demand for CVS's health-related products.

The trend towards value-based care aligns with CVS's integrated healthcare approach.

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