CVS Health

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Manager, Dental Network Management

at CVS Health

Job Description

Job Description
**Seeking qualified candidates preferably in the Central or Western half of the country for this role**

The Manager, Dental Network Management manages a unit that negotiates, executes, conducts review and analysis, dispute resolution and/or settlement negotiations of contracts with larger and more complex group/system providers in accordance with company standards to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals and cost initiatives. Maintains accountability for specific medical cost initiatives.

Fundamental Components
Manages a team of professional analysts and negotiators to negotiate complex, competitive contractual relationships with providers according to prescribed guidelines and financial standards in support of national and regional network strategies.Manages contract performance and supports the development and implementation of standard and/or value-based contract relationships in support of business strategies. Recruits providers as needed to ensure attainment of network expansion and adequacy targets. May manage provider contract support functions including the development of boiler plate contracts and state filings; contract support, review & approval, and information analysis to ensure the development of cost-effective provider contracts.Manages provider compensation/reimbursement and pricing development activities in partnership with business management.Manages the analysts and contract specialists accountable for cost arrangements within defined groups. Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities.Partner with business to determine network and contract needs.Responsible for reporting, understanding and managing medical cost issues and initiating appropriate action in partnership with business.Serves as SME for less experienced team members and internal partners. Provides sales and marketing support, community relations and guidance with comprehension of applicable federal and state regulations.May provide network development, maintenance, and refinement activities and strategies in support of cross-market network management unit. Assists with the design, development, management, and or implementation of strategic network configurations and integration activities.May optimize interaction with assigned providers and internal business partners to manage relationships to ensure provider needs are met. Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.Initiate legal reviews as needed; ensure all required reviews completed by appropriate functional areas.Required to communicate w/internal/external parties by phone/in person; may require travel to offsite locations.


Background Experience
5 to 7 years experience in healthcare. A successful track record of managing and negotiating provider contracts that improve competitive position. In depth knowledge of various reimbursement structures and payment methodologies. Solid leadership skills including staff development. Critical thinking and problem solving skills Bachelor's degree or equivalent experience. Masters degree preferred, but not required

Additional Job Information
Job description may also be used for other products besides Commercial medical: e.g., dental, worker’s comp, behavioral health, Medicare, Medicaid, etc.; systems and tools mentioned in the description would align and reflect appropriate product, segment.

Bachelor's degree or equivalent experience

Percent of Travel Required
10 - 25%

Business Overview
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.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!