Senior Manager, Provider Contract Network Management

Richmond, Virginia, United States

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Not SpecifiedCompensation

Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Health InsuranceIndustries

Requirements

Candidates must have 7+ years of related experience and expert-level negotiation skills with a successful track record negotiating contracts with large or complex provider systems. Strong communication, critical thinking, problem resolution, and interpersonal skills are required, along with proven working knowledge of provider financial issues, competitor strategies, complex contracting options, financial/contracting arrangements, and regulatory requirements. Medicaid Network Management experience is necessary, and candidates must reside within the Commonwealth of Virginia. A Bachelor's Degree is preferred or relevant professional experience.

Responsibilities

The Senior Manager will negotiate, execute, review, and analyze contracts with large and complex provider systems to maintain and enhance provider networks while meeting accessibility, quality, and financial goals. Responsibilities include analyzing market needs for network expansion, identifying gaps, and seeking new provider relationships. The role ensures governance with healthcare regulations and contractual requirements, initiates contracting activities, and collaborates on negotiations with providers. The Senior Manager will also participate in meetings as a department representative, support operational activities like database management, provide recommendations to leadership, and coach junior colleagues in contracting techniques.

Skills

Contract Negotiation

Provider Network Management

Healthcare Regulations

Contract Management

Dispute Resolution

Financial Goals

Market Analysis

Credentialing

Database Management

Leadership Recommendations

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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