Senior Provider Network Contracting Manager - Medicaid Behavioral Health

$67,900 - $149,328/Yr

CVS Health - Frankfort, KY

Full-time - Mid Level

Frankfort, KY

Health and Personal Care Retailers

About the position

The Senior Provider Network Contracting Manager for Medicaid Behavioral Health at CVS Health is responsible for reviewing, analyzing, negotiating, and executing complex Medicaid contracts with various healthcare providers. This role aims to maintain and enhance provider networks while ensuring compliance with accessibility, quality, and financial goals. The manager collaborates cross-functionally to develop compensation strategies and serves as a liaison to interpret contracts and resolve service issues.

Responsibilities

• Review, analyze, negotiate, and execute complex Medicaid contracts with health systems, physician groups, and behavioral health providers.
• Maintain and enhance provider networks to meet accessibility, compliance, quality, and financial goals.
• Collaborate cross-functionally to develop provider compensation and pricing strategies.
• Manage contracts through language and compliance reviews.
• Serve as a liaison to internal colleagues to interpret contracts and resolve claims and service issues.

Requirements

• 7-10 years of work experience in a provider contracting role, preferably in Medicaid and/or behavioral health.
• Proven knowledge of physician reimbursement methodologies and contracting strategies.
• Strong communication, critical thinking, project management, and problem-solving skills.
• Willingness to interact with providers and engage in complex conversations.
• Working knowledge of Microsoft applications.
• Adept at negotiating complex healthcare provider contracts.

Nice-to-haves

• Working knowledge of QuickBase, QNEXT, PRMS, and KIT systems.

Benefits

• Full range of medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Employee Stock Purchase Plan.
• Fully-paid term life insurance plan.
• Short-term and long-term disability benefits.
• Well-being programs.
• Education assistance and free development courses.
• CVS store discount and discount programs with participating partners.
• Paid Time Off (PTO) and paid holidays.