Provider Network Manager

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 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, maintaining and enhancing provider networks to meet accessibility, quality, financial goals and cost initiatives for our Medicaid products. Responsibilities Negotiate, execute, and conduct high‑level review and rate analysis, dispute resolution or settlement negotiations of contracts with larger and more complex regional hospital systems, large physician groups, and ancillaries. Manage contract performance and support the development and implementation of strategic value‑based contracts, maintaining provider networks to meet accessibility, quality, financial goals and cost initiatives for Medicaid products. Recruit providers as needed to ensure attainment of network expansion and adequacy targets. Identify and manage cost issues, initiating appropriate cost‑saving initiatives and/or settlement activities. Represent the company with high‑visibility constituents, including customers and community groups. Promote collaboration with internal partners and optimize interactions with providers and business partners to facilitate relationships and meet provider needs. Participate in JOC meetings. Manage complex contractual relationships with providers per prescribed guidelines in support of national and regional network strategies. Support development and implementation of value‑based contract relationships in support of business strategies. Be accountable for cost arrangements within defined groups. Collaborate cross‑functionally to manage hospital, ancillary, and provider compensation and pricing development activities, submit contractual information, and review and analyze reports for negotiation and reimbursement modeling activities. Serve as SME for less experienced team members and internal partners. Provide network development, maintenance, and refinement activities and strategies in support of cross‑market network management units. Assist with design, development, management, and/or implementation of strategic network configurations and integration activities. Ensure resolution of escalated issues related to claims payment, contract interpretation, parameters, or accuracy of provider contract or demographic information. Required Qualifications 7+ years of healthcare industry experience. 5+ years of related experience and comprehensive provider‑negotiating skills with a successful track record negotiating contracts with complex provider systems or groups. Must reside in Michigan. Critical thinking skills to maintain cost management and a fully engaged network of participating hospitals, ancillaries, and providers. Proficiency in Microsoft Office/Excel. Ability to travel in the 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 interpersonal skills. Understanding of Value‑Based Contracting. Internal Aetna system knowledge is a plus. Understanding of Medicaid. Proven 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: $75,400.00 – $165,954.00. 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 and includes an award target in the company’s equity award program. Benefits Medical, dental, and vision coverage. Paid time off. Retirement savings options. Wellness programs. Other resources based on eligibility. EEO Statement Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Application Closing Date We anticipate the application window for this opening will close on: 08/01/2026 #J-18808-Ljbffr