Medicaid Program Manager Jobs in Michigan (NOW HIRING)

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Position Summary

In this individual contributor role the Network Management Senior Manager will negotiate, execute, and conduct high level review and rate analysis, dispute resolution and/or settlement negotiations of contracts with larger and more complex, regional based hospital systems, large physician groups, and ancillaries in accordance with company standards.

As a Senior Network Manager you will manage contract performance and support the development and implementation of strategic, value-based contract relationships, maintain and enhance provider networks to meet accessibility, quality, financial goals and cost initiatives for our Medicaid products.

• Negotiate and execute provider contracts, conduct high level review and analysis, dispute resolution and/or settlement negotiations of contracts with larger and more complex, market-based, hospitals, health systems group/system providers.

• Recruit providers as needed to ensure attainment of network expansion and adequacy targets.

• Responsible for identifying and managing cost issues and initiating appropriate cost saving initiatives and/or settlement activities.

• Represents company with high visibility constituents, including customers and community groups. Promotes collaboration with internal partners.

• Optimize interaction with assigned providers and internal business partners to facilitate relationships and ensure provider needs are met.

• Participates in JOC meetings.

• Manages complex, contractual relationships with providers according to prescribed guidelines in support of national and regional network strategies.

• Manages contract performance and supports the development and implementation of value-based contract relationships in support of business strategies.

• Accountable for cost arrangements within defined groups.

• Collaborates cross-functionally to manage Hospital, Ancillary and 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

• Serves as SME for less experienced team members and internal partners.

• Provides network development, maintenance, and refinement activities and strategies in support of cross market network management unit.

• Assists with the design, development, management, and or implementation of strategic network configurations and integration activities.

• Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.

Required Qualifications

• 7+ years healthcare industry experience

• 5+ years related experience and comprehensive level of provider negotiating skills with successful track record negotiating contracts with complex provider systems or groups.

• Must reside in Michigan

• Critical thinking to maintain cost management and a fully engaged network of participating hospitals, ancillaries and providers.

• Microsoft Office/Excel proficient

• Ability to travel in assigned market up to 10-15% of the time as needed (Michigan).

Preferred Qualifications

• Healthcare Industry experience with either a payer or provider

• Strong communication, critical thinking, problem resolution and interpersonalskills.

• Understanding knowledge of Value Based Contracting.

• Internal Aetna system knowledge a plus.

• Understanding of Medicaid.

• Proven working knowledge of provider financial issues and competitor strategies, complex contracting options, financial/contracting arrangements and regulatory requirements.

Education

• Bachelor's Degree or equivalent professional work experience.

Pay Range

The typical pay range for this role is:

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 people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.