Job Description:
• Direct groups managing provider contract performance
• Support development and implementation of strategic, value-based contract relationships
• Negotiate network contracts with healthcare providers
• Establish reimbursement rates, service agreements, and performance metrics
• Advise on provider performance, network adequacy, geographical coverage, and member satisfaction
• Make necessary network modifications or expansions
• Implement improvement initiatives to ensure network providers meet regulatory and quality standards
• Develop and expand the network by identifying and contracting with hospitals, physicians, specialists, and ancillary service providers
• Conduct market analysis and assess competitive positioning
• Recommend strategies to maintain a competitive edge
• Interface with finance on budgeting, cost analysis, and financial forecasting
• Consult with medical directors, operations managers, and network development professionals
• Provide recommendations to senior leadership to guide decision-making and align with organizational goals
Requirements:
• 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
• Bachelor’s degree preferred/specialized training/relevant professional qualification
• Problem solving and decision-making skills
• Collaboration and teamwork skills
• Growth mindset, including agility and developing yourself and others
• Execution and delivery skills, including planning, delivering, and supporting
• Business intelligence skills
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
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