We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Position Summary
The Senior Manager of Network Management is a critical role in advancing the organization’s Value-Based Contracting (VBC) strategy for the Louisiana Medicaid Market. This position is essential to developing and managing provider relationships that drive improved health outcomes, cost efficiency, and compliance with state and federal Medicaid obligations.
Directs groups to manage provider contract performance and supports the development and implementation of strategic, value-based contract relationships.
Applies highly developed knowledge to negotiate Network contracts with healthcare providers, establish reimbursement rates, service agreements, and performance metrics.
Advises on provider performance, network adequacy, geographical coverage, and member satisfaction, and makes necessary network modifications or expansions.
Implement improvement initiatives to ensure that network providers meet all applicable regulatory and quality standards.
Develops and expands the network, identifying and contracting with healthcare providers, including hospitals, physicians, specialists, and ancillary service providers.
Conducts market analysis, assesses competitive positioning, and recommends strategies to maintain a competitive edge.
Interfaces with the finance team on budgeting, cost analysis, and financial forecasting, to manage the financial aspects of provider network management.
Consults with internal teams, including medical directors, operations managers, and network development professionals, to align provider network performance goals and objectives.
Provides continuous recommendations to senior leadership to guide decision-making and ensure close alignment with the organization's strategic goals and objectives.
Required Qualifications
Minimum 7 years of experience in provider network management, contract negotiations, or value-based contracting within Medicaid or managed care programs.
Strong understanding of Medicaid reimbursement models, value-based care, and risk sharing arrangements.
Demonstrated ability to analyze financial and quality performance data and implement process improvements.
Experience with provider performance measurement, quality improvement and building strong provider partnerships.
Reside in the Louisiana market.
Preferred Qualifications
Adept at problem solving and decision-making skills
Adept at collaboration and teamwork
Adept at growth mindset (agility and developing yourself and others) skills
Adept at execution and delivery (planning, delivering, and supporting) skills
Adept at business intelligence
Education
Bachelor’s degree preferred/specialized training/relevant professional qualification.
Pay Range
The typical pay range for this role is:
$67,900.00 - $149,328.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. 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 listed above. This position also includes an award target in the company’s equity award program.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Job details are sourced from the employer's original posting.
Open job postingAbout the company
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come. Excellent benefits package, including 401k, tuition, licensure and certification reimbursement. We promote healthy & wellness lifestyles and offer specialty programs here at Aetna. We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence. Together we will empower people to live healthier lives. Benefit eligibility may vary by position. Click here to review the benefits associated with this position. Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities. We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.