Manager, Network Management (National Health Systems)

Position Summary

Constructs negotiation, execution, review, and analysis of contracts. Delivers dispute resolution and settlement negotiations with providers. Ensures contract performance aligns with accessibility, compliance, quality, financial, and cost goals. Develop, maintain, and enhance working relationships with physicians/providers and local network and patient management teams in the markets with Aetna.

Key Responsibilities

• Establishes and implements programs and innovative initiatives for the organization to advance Contract Negotiations initiatives.
• Forecasts changes within the Contract Negotiations industry, conducts business impact assessments, and develops modification strategies with the aid of process improvement methodologies.
• Integrates cross-functional collaboration to contribute to provider compensation and pricing development activities and recommendations for negotiations and reimbursement modeling activities.
• Determines recommendations to manage cost issues and support cost-saving initiatives and settlement activities.
• Assists in the management of network development, maintenance, and refinement activities and strategies in support of cross-market network management units.
• Coaches more junior colleagues in techniques, processes, and responsibilities.
• Other duties and responsibilities as assigned by manager.

Required Qualifications

• 5+ years of provider contracting, claims management, or patient management experience.
• 5+ years experience working with or in a Claims environment.
• 5+ years experience that includes ACAS and HRP claim platforms, products, and benefits; patient management, provider relations, or claims management.

Preferred Qualifications

• Experience with Aetna systems (SCM, Smart Front End, Rate Inquiry, Contract Inquiry).

Education

Bachelor's degree preferred or a combination of professional work experience and education.

Pay & Benefits

• Pay range: $54,300.00 – $159,120.00 annually (actual offer depends on experience, education, geography, and other factors).
• Eligible for a CVS Health bonus, commission, or short-term incentive program in addition to base pay.
• Comprehensive benefits package including medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources (based on eligibility).