Acts as the primary resource for assigned profile of larger and more complex providers (i.e. market/ regional/national, large group or hospital systems) to establish, oversee, and maintain provider risk management and positive relationships and supports high value initiative activities.
Drives the implementation of internal and external solutions to achieve provider satisfaction, cost targets, network growth, and efficiency targets.
May have limited contract negotiation responsibilities for assigned providers.
Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships and partners on the development of business strategy and programs to
support the operational plans.
Collaborates cross-functionally to ensure resolution of escalated issues or projects for assigned provider systems and monitors performance and adherence to scorecards and payout schedules based on established quality, growth and clinical measures.
Educates internal and external parties as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, performance measurement techniques, policies, and procedures.
Meets with key providers periodically to ensure service levels are meeting expectations.
Manages the development of agenda, validates materials, and facilitates external provider meetings.
May collaborate cross-functionally on the implementation of large provider systems, to manage cost drivers, data reports and execute specific cost initiatives to support business objectives and to identify trends and enlist assistance in problem resolution.
May be responsible for provider recruitment, contracting, or re-contracting activities, or may assist and support more complex contracting and discussions.
May provide guidance and training to less experienced team members.
Must live in New Jersey
Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills with proven ability to influence and collaborate with providers and partners at all levels.
4+ years' experience in business segment specific environment servicing or managing non-standard relationships with providers with exposure to
benefit plan design and/or contract interpretation.
3-5 years' experience with business segment specific policy, benefits, plan design and language.
Working knowledge of business segment specific codes, products, and terminology.
Bachelor's Degree or equivalent combination of education and experience.
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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