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CVS Health

Runs pharmacies, health plans and clinics

Manager, Contract Negotiations - Louisiana Medicaid

Procurement & SourcingConfirmed live in the last 24 hours
Full-timeLouisiana, USA

About the Job

Requirements

  • Three to five years of related experience with a successful track record negotiating managed care provider contracts with physician groups, hospitals, and/or ancillary services.
  • In-depth knowledge of the managed care industry and practices, including strategies and financial and contracting reimbursement methodologies.
  • Proficiency with Microsoft Office Suite.
  • Ability to travel in the assigned market up to 15% of the time as needed.
  • Must be a Louisiana resident and able to work in the Baton Rouge office at least one to two times per month.
  • Bachelor’s degree or equivalent combination of education and experience.

Responsibilities

  • Recruit, negotiate, and execute physical and behavioral health provider contracts to meet Aetna Better Health of Louisiana network expansion and adequacy targets.
  • Optimize interactions with assigned providers and internal business partners to facilitate relationships and ensure provider needs are met.
  • Identify and manage cost issues and initiate appropriate cost-saving initiatives and/or settlement activities.
  • Assist with the design, development, management, and implementation of strategic network configurations and integration activities.
  • Resolve escalated issues related to claims payment, contract interpretation and parameters, or the accuracy of provider contract or demographic information.
  • Manage complex contractual relationships with providers according to prescribed guidelines in support of national and regional network strategies.
  • Collaborate cross-functionally on hospital, ancillary, and provider compensation and pricing development activities, submission of contractual information, and review and analysis of reports for negotiation and reimbursement modeling activities.

Desired Qualifications

  • Knowledge of the Louisiana Medicaid provider and payor landscape.
  • Strong communication, critical thinking, problem-resolution, and interpersonal skills.

About the Company

CVS Health

Runs pharmacies, health plans and clinics

CVS Health runs pharmacies, health insurance plans and medical clinics for individuals, employers and government programs across the United States. Its businesses include CVS Pharmacy, the Aetna insurer and Caremark, which manages prescription coverage and negotiates drug prices for health plans. Patients fill prescriptions in stores or by mail and receive care through walk-in clinics, primary care centers and home visits. The company earns money from prescription sales, insurance premiums, plan administration fees and clinical services, combining coverage with places to obtain treatment. Its first store opened in 1963, and its headquarters are in Woonsocket, Rhode Island.

Company size
10,001+
Company stage
IPO
Headquarters
Woonsocket, Rhode Island
Founded
1963

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