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CVS Health

Network Manager

Wilmington, DE

Job Description
Negotiates, executes, conducts high level review and
analysis, dispute resolution and/or settlement negotiations
of contracts with larger and more complex,
market/regional/national based group/system providers in
accordance with company standards in order to maintain
and enhance provider networks while meeting and
exceeding accessibility, quality and financial goals and
cost initiatives.

Required Qualifications
-Negotiates and executes, conducts high level review
and analysis, dispute resolution and/or settlement
negotiations of contracts with larger and more complex,
market-based, group/system providers.
-Manages contract performance and supports the
development and implementation of value based

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contract relationships in support of business
-Recruits providers as needed to ensure attainment
of network expansion and adequacy targets.
-Accountable for cost arrangements within defined
-Collaborates 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/or settlement activities.
-Assists with the design, development, management,
and or implementation of strategic network
configurations and integration activities. May optimize
interaction with assigned providers and internal business
partners to manage relationships to ensure provider needs
are met.
-Ensures resolution of escalated issues related, but not
limited to, claims payment, contract interpretation and
parameters, or accuracy of provider contract or
demographic info.

COVID Requirements
CVS Health requires its Colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, or religious belief that prevents them from being vaccinated.

If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 10 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 45 days of your employment. In some states and roles, you may be required to provide proof of full vaccination before you can begin to actively work. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.

If you are unable to be fully vaccinated due to disability, medical condition, or religious belief, you will be required to apply for a reasonable accommodation within the first 10 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. In some states and roles, you may be required to have an approved reasonable accommodation before you can begin to actively work. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications
-Proven working knowledge of provider financial
issues and competitor strategies, complex
contracting options, financial/contracting arrangements
and regulatory requirements.
-5-7 years related experience and comprehensive
level of negotiating skills with successful track record
negotiating contracts with individual or complex
provider systems or groups.
-Strong communication, critical thinking, problem
resolution and interpersonal skills.

Bachelor's Degree or equivalent combination of
education and experience.

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.

Job ID: CVS-1845843BR_82227959
Employment Type: Other

Perks and Benefits

  • Health and Wellness

    • Health Insurance
    • Dental Insurance
    • Vision Insurance
    • Life Insurance
    • HSA
    • HSA With Employer Contribution
    • Pet Insurance
    • Mental Health Benefits
  • Parental Benefits

    • Fertility Benefits
    • Adoption Assistance Program
    • Family Support Resources
  • Work Flexibility

    • Flexible Work Hours
    • Remote Work Opportunities
    • Hybrid Work Opportunities
  • Vacation and Time Off

    • Paid Vacation
    • Paid Holidays
    • Personal/Sick Days
  • Financial and Retirement

    • 401(K) With Company Matching
  • Professional Development

    • Tuition Reimbursement
  • Diversity and Inclusion

    • Employee Resource Groups (ERG)
    • Diversity, Equity, and Inclusion Program