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Position Summary
The Senior Manager, Network Management, serves a critical role in advancing Provider Network strategy for the Louisiana Medicaid Market. This position is essential to monitor and manage our proactive network strategy ensuring compliance with LDH and NCQA standards while optimizing cost-effective care delivery and access to care for our members.
Other duties include but not limited to:
- Support NCQA accreditation and compliance with Louisiana Dept. of Health (LDH) network standards by monitoring monthly progress towards annual network development plan objectives and providing alternative strategies to achieve at-risk goals.
- Conducts market analysis, assesses competitive positioning, and recommends strategies to identify opportunities for market growth and provider partnerships.
- Build internal pipeline of provider recruiting targets by priority and create departmental training materials on identifying appropriate targets in response to various LDH and market initiatives.
- Design NM activity dashboard to promote leadership visibility into contracting productivity, project status, and escalation requests.
- Develop and deploy engagement and change strategies that accelerate adoption of new processes, tools, and operational practices.
- Provide real-time recommendations to senior leadership to guide decision-making and ensure close alignment with the organization's strategic goals and objectives.
- Partner with matrixed leaders to diagnose organizational challenges and identify solutions that improve clarity, effectiveness, and outcomes.
- Recruit providers as needed to ensure attainment of network expansion and adequacy targets.
- Responsible for identifying and managing cost issues and initiating appropriate cost saving initiatives and/or settlement activities.
- Represents company with high visibility constituents, including customers and community groups. Promotes collaboration with internal partners.
- Optimize interaction with assigned providers and internal business partners to facilitate relationships and ensure provider needs are met.
- Participates in JOC meetings.
- Manages complex, contractual relationships with providers according to prescribed guidelines in support
- of national and regional network strategies.
- Collaborates cross-functionally to manage Hospital, Ancillary and 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
- Serves as SME for less experienced team members and internal partners.
- Provides 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.
- Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation
- and parameters, or accuracy of provider contract or demographic information
Required Qualifications
- 7+ years of experience in Medicaid managed care provider contracting, provider engagement, performance management, or value-based contracting.
- Strong understanding of Medicaid provider environment and reimbursement models.
- Experience with internal / external stakeholder engagement and partnership.
- Must live in the Louisiana market
- Ability to travel in assigned market up to 20% of the time as needed
- Strong communication, critical thinking, problem resolution, and interpersonal skills.
Preferred Qualifications
- Knowledge of Louisiana Medicaid landscape
- Solution-driven approach to provider challenges
- Change-enablement strategies and execution experience
- Adept at business intelligence.
- Experience negotiating contracts with complex provider systems or groups
Education
- Bachelor's degree or equivalent 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.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on Benefits Moments.
We anticipate the application window for this opening will close on: 10/05/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
