Network Operations Consultant - CVS Health (California)
Job Description
Serves as the subject matter expert in support of contracting initiatives and data audits to enhance provider networks while meeting and exceeding accessibility, compliance, quality, and financial goals. Responsible for reviewing, building and auditing complex contract and network data, support recruitment efforts, and collaborate on negotiations as needed.-• Responsible for reviewing, building, loading, and auditing complex contracts, agreements, amendments and/or fee schedules in contract management systems.-• Conducts research, analysis and/or audits to identify issues and propose solutions to protect data, contract integrity and performance.-• Provides technical expertise for questions related to contracting and related systems and information contained.-• Partner across the organization to support network development, maintenance, refinement activities, regulatory filings, migration and rate activities.-• May coordinate complex contracting activities, implementation, coordinate receipt and processing of contracts and documentation and pre-and post-signature review of contracts and language modification.-• Collaborates on negotiations or may handle contracting and re-contracting discussions with solo providers or small groups.-• May conduct or assist with service activities such as provider education, technology usage, or process updates.-• May recruit providers in support of network management and expansion initiative or analyze market data for outreach mailings to desired expansion targets.
Required Qualifications
-• 3 years related experience. Knowledge of basic negotiating skills desired.-• Proven working knowledge of standard provider contracts, provider contract financial terms, and contract language desired.-• Strong communication, critical thinking, problem resolution and interpersonal skills.-• Bachelor’s Degree or equivalent combination of education and experience.
Preferred Qualifications
Please review required qualifications above
Education
Bachelor's degree or equivalent experience
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.
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