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Position Summary

The Sr. Manager Medicaid Value Based Care (VBC) FL manages and oversees compliance with our Network responsibilities as provided within the State Medicaid contractual requirements as outlined below:

• Accountable for working with our strategic provider partners to develop innovative value-based solutions to meet total cost and quality goals for our Medicaid businesses.

• Responsible for designing conceptual models, initiative planning, and negotiating high value/risk contracts with the most complex and challenging, market/region/national, largest group/system or highest value/volume of spend providers in accordance with company standards in order to maintain and enhance provider networks, while working cross functionally to ensure consistency with all contracting strategies and meeting and exceeding accessibility, quality, compliance, and financial goals and cost initiatives.

• Works with Plan Leadership, Quality, VBS reporting team and other staff to manage contract performance and drives the development and implementation of value based contract relationships in support of business strategies.

• Recruits providers as needed to ensure attainment of network expansion and adequacy targets. Accountable for cost arrangements within defined groups.

• Evaluates, helps formulate, and implements the provider network strategic plans to achieve value based contracting targets and manage medical costs through effective value based contracting to meet state contract and product requirements.

• The State Network Manager will assist in the recruitment of new value based providers as needed and maintain compliance with all state value based requirements.

• Recommend training programs and educational materials for providers as well as for internal staff and aligns Network functions with Operations and Claims as needed.

• Recommend Network Action Plans to ensure Network Compliance with any and/all State Network Compliance requirements

Role/responsibilities

• In charge of complete value based contracting cycle from planning, creating documents, and negotiation to oversee loading of executed arrangements.

• Represent company with high visibility constituents, including customers and community groups. Promotes collaboration with internal partners.

• Works with health plan staff to create a value based strategic plan with targeted provider groups to ensure we meet state guidelines for value based provider agreements

• Continuous review of value based provider performance and movement of providers along the value based continuum as they are ready.

• Facilitates and attends, as needed, including Traveling externally when required for, Provider meetings and negotiations.

• Oversees the monitoring and loading of executed value based provider contracts to ensure State requirements.

• Coordinate’s provider information with member services and other internal departments as requested.

• Evaluates, helps formulate, and implements the provider network strategic plans to achieve contracting targets and manage medical costs through effective provider contracting to meet state contract and product requirements.

• Collaborates with internal partners to assess effectiveness of tactical plan in managing costs. May optimize interaction with assigned providers and internal business partners to facilitate relationships and ensure provider needs are met.

• Provides assistance and support to other departments, as needed, to obtain crucial or required information from Providers, such as HEDIS, Credentialing, Grievance and Appeals, SIU, etc. Coordinates provider status information with member services and other internal departments.

Required Qualifications

• Minimum of 3 years of Managed Care Network Value Based Contracting experience with a minimum of 2 years Medicaid Network experience

• Must have Microsoft Office experience with intermediate to advanced Word, Excel, Teams and PowerPoint skills.

• Reside within Florida and travel within the state.

​ Preferred Qualifications

• Excellent interpersonal skills and the ability to work with others at all levels

• Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and Network Performance Standards

• Excellent analytical and problem-solving skills

• Strong communication, negotiation, and presentation skills

• Proven ability to work in a matrixed organization

​ Education

• Bachelor’s degree or equivalent professional work experience.

Pay Range

The typical pay range for this role is:

$67,900.00 - $149,328.00

This 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.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit Benefits | CVS Health (https://jobs.cvshealth.com/us/en/benefits)

We anticipate the application window for this opening will close on: 01/25/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.