Job Description:
• Establish and maintain productive value-based relationships with key network providers
• Develop and manage the Keystone Value-based Network
• Build strategic provider-partner relationships and develop innovative value-based solutions to meet total cost and quality goals
• Develop alternative payment models and identify and plan new initiatives
• Negotiate high-value/risk contracts with complex arrangement structures
• Understand providers’ volume and cost structures
• Work cross-functionally to identify negotiation levers and critical negotiation points
• Align negotiation strategies and tactics with network accessibility, quality, compliance, and financial performance goals
• Manage the complete value-based contracting cycle, including planning, document creation, negotiation, and loading executed arrangements
• Work with Performance, Clinical Transformation, VBS Analytics, and other internal teams to develop strategic plans and oversee contract performance
• Evaluate, formulate, and implement network strategic plans to achieve value-based contracting targets and manage medical costs
• Support other departments in obtaining required provider information, including HEDIS, Credentialing, Grievance and Appeals, and SIU information
• Coordinate provider status information with member services and other internal departments
• Lead complex projects and programs from assessment through implementation across processes, systems, functions, and products
• Facilitate and attend external provider meetings and negotiations as needed
Requirements:
• 10 years of related experience
• Comprehensive negotiating skills with a successful track record negotiating value-based contracts with IPAs, large complex provider systems or groups, hospitals and large physician entities
• Experience reviewing medical claims data
• Experience developing executive summaries and identifying opportunities to mitigate medical cost trends
• Excellent analytical and problem-solving skills
• Strong communication, negotiation, and presentation skills
• Ability to work in a matrixed organization, gain consensus, and share information with various interested parties
• Familiarity with legal terms in the context of provider contracting preferred
• Familiarity with CMS Stars and HEDIS technical specifications and measurable percentiles associated with HEDIS measures preferred
• Experience with Commercial, Medicare and Medicaid contracting preferred
• Ability to apply systems thinking when managing multiple provider value-based initiatives preferred
• Strong financial modeling background preferred
• Bachelor’s degree preferred or a combination of professional work experience and education
Benefits:
• Medical coverage
• Dental coverage
• Vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources supporting physical, emotional, and financial well-being
• CVS Health bonus, commission or short-term incentive program
• Equity award program