Network Relations Consultant, Network Mgmt (healthcare) (remote)
CVS Health
28,794 reviews
Tampa, FL
Remote
CVS Health
28,794 reviews
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Remote position with ability to support eastern and central time zones.
CVS Health is on a mission to improve the health and mental wellbeing of the people in our communities. Looking to be on the forefront of healthcare, technology, and innovation? Aetna’s Mental Wellbeing organization delivers and manages impactful products and programs that expand convenient access to high-quality and accordable mental and behavioral health services that support all people across all stages of everyday life.
Position Overview
This position negotiates, executes, analyzes, and services contracts, manages provider relationships and dispute resolution and settlement negotiations with smaller providers (i.e. local, individual providers, small groups/systems) that will advance and differentiate the Behavioral Health and EAP Network in accordance with company standards in order to maintain and enhance provider networks and exceed accessibility, quality, and financial goals and cost initiatives.
Position Accountabilities
• Negotiates, executes, analyzes, and services provider contracts, in addition to managing contract performance and provider relationships in support of business strategies.
• Conduct high level review and analysis, dispute resolution and/or settlement negotiations of contracts with local market providers and groups (i.e. local, individual providers, small groups/systems).
• Recruits providers and drives provider engagement as needed to ensure attainment of network expansion and adequacy targets.
• Support the network onboarding team in managing standard contracts and provider relationships.
• 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.
• Optimizes 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 information.
• Provides network development, maintenance, and refinement activities and strategies in support of cross-market network management unit.
Required Qualifications
2+ years' experience in business segment environment servicing providers with exposure to benefits and/or contract interpretation.
Knowledge of provider operations, financial/contracting arrangements, and regulatory requirements.
Proven working knowledge of standard provider contracts, terms, and language.
Knowledge of basic negotiating skills desired.
Ability to support eastern and central time zones
COVID Requirements
COVID-19 Vaccination Requirement
CVS Health requires certain 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, religious belief, or other legally recognized reasons that prevents them from being 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 or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
Preferred Qualifications
Contracting and Provider Network Experience
Health Insurer Experience
Negotiation Experience
Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills
Demonstrated ability to handle multiple assignments competently, accurately, and efficiently.
Education
Associates or BS degree or 2 years experience directly related to the duties and responsibilities specified.
Business Overview
Bring your heart to CVS Health
Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day.
CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
Hiring Insights Job activity Posted 1 day ago