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.The Senior Manager of Value-Based Contracting is responsible for establishing and maintaining productive value-based relationships with key network providers. Responsible to develop and manage the Value-based Network within the Central Region as outlined below:
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- Accountable for building strategic relationships with our provider partners to develop innovative value-based solutions to meet total cost and quality goals.
- Responsible for developing alternative payment models, identifying and planning new initiatives, and negotiating high value/risk contracts with the most complex arrangement structures, which requires:
- understanding providers' volume and cost structure
- working cross functionally to identify the levers and critical negotiation points
- aligning negotiation strategies and tactics with network accessibility, quality, compliance, and financial performance goals
- In charge of complete value-based contracting cycle from planning, creating documents, negotiation and loading of executed arrangements.
- Works with Performance team, Clinical Transformation team, VBS Analytics team and other key internal teams to develop a value-based strategic plan and oversee contract performance with targeted provider groups to ensure we meet objectives for value-based provider agreements.
- Evaluates, helps formulate, and implements network strategic plans to achieve value-based contracting targets and manage medical costs through effective value-based contracting.
- Provide assistance and support to other departments, as needed, to obtain crucial or required information from providers, such as HEDIS, Credentialing, etc.
- Leads work and deliverables of complex projects/programs, through assessment to implementation, that may impact multiple processes, systems, functions, and products across all lines of business.
- Facilitates and attends external provider meetings and negotiations, as needed.
- Manage Value-Based ACO products (Aetna Whole Health local networks); this may include day-to-day management in addition to the contracting of ACO product deal terms.
- 5+ years of related experience and comprehensive level of negotiating skills with successful track record negotiating value-based contracts with IPAs, large complex provider systems or groups, hospitals and large physician and risk bearing entities
- Experience developing executive summaries and identifying opportunities for mitigating medical cost trend
- Excellent analytical and problem-solving skills
- Strong communication, negotiation, and presentation skills
- Ability to work in a matrixed organization and gain consensus and share information to various interested parties
- Familiar with legal terms in the context of provider contracting
- Familiar with CMS Stars and HEDIS technical specifications and various measurable percentiles associated with the HEDIS measures
- Experience with Commercial, Medicare, and Individual Exchange contracting
- Able to apply system thinking when managing multiple provider value-based initiatives
- Strong financial modeling background
- Bachelor's degree preferred or a combination of professional work experience and education.
The typical pay range for this role is:$0.00 - $0.00
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 peopleWe 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.