Network Development and Contracting (Value Based Care) Medicaid (NJ/PA/NY)

4062 Aetna Resources, LLC; New York (NY); Hybrid; USD 75,000 - 183,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Paid time off

Retirement plan

Wellness programs

Job summary

CVS Health is seeking a Medicaid VBS Network State Manager to oversee value-based contracting and Medicaid network compliance. You will negotiate arrangements, load contracts, and drive provider engagement to meet state guidelines and cost targets.

The role requires 7+ years in Managed Care Network VBC with Medicaid experience, strong Excel/PowerPoint skills, and the ability to travel within the state from a remote location.

Qualifications

• Minimum 7 years recent Managed Care Network Value Based Contracting experience with 2-3 years Medicaid Network experience.
• Proficient in Microsoft Office with intermediate to advanced Excel and PowerPoint.
• Excellent interpersonal, analytical and problem-solving abilities.
• Strong communication, negotiation and presentation skills.
• Experience working in a matrixed organization and residency within the state.

Responsibilities

• Oversee compliance with Medicaid contractual requirements and value-based contracting.
• Negotiate payment arrangements and load executed contracts while monitoring performance.
• Coordinate with internal teams to promote value-based solutions and provider relationships.
• Recruits providers to meet network expansion and adequacy targets and ensure state compliance.

Skills

Interpersonal skills

Communication

Negotiation skills

Presentation skills

Analytical thinking

Problem-solving

Excel

PowerPoint

Education

Bachelor’s degree or equivalent

Job description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary

The Medicaid VBS Network State Manager 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 promote innovative value-based solutions to meet total cost and quality goals for our Medicaid businesses. Responsible for deploying alternative payment models, executing new initiatives, and negotiating value-based contracts with the templated payment structures, which requires: Basic understanding the providers’ volume and cost structure Conducting negotiation following PADU tool, and Aligning negotiation tactics with goals encompassing network accessibility, quality, compliance and financial performance. Works with Practice Transformation Team, VBS reporting team and other key internal teams to develop a value based strategic plan and manage contract performance with targeted provider groups to ensure we meet state guidelines for value based provider agreements. In charge of complete value based contracting cycle from planning, creating documents, and negotiation to oversee loading of executed arrangements. That includes, but not limited to: Recruits providers to ensure attainment of network expansion and adequacy targets. Accountable for negotiation of payment arrangements with providers and operation ability of the established contracts. Oversees the monitoring and loading of executed value-based provider contracts to ensure State requirements. 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. This Position will manage combined functions for external provider engagement representatives and internal provider relations representatives to ensure successful Provider Relationships, and Network Performance including Clinical and Affordability Targeted Improvements as identified. That includes, but not limited to: Represents company with high visibility constituents, including customers and community groups. Promotes collaboration with internal partners. Continuous review of value based provider performance and movement of providers along the value based continuum as they are ready. Recommend training programs and educational materials for providers as well as for internal staff and aligns Network functions with Operations and Claims as needed. 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. Facilitates and attends, as needed, including Traveling externally when required for, Provider meetings and negotiations. Coordinate’s provider information with member services and other internal departments as requested. 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 7 years recent Managed Care Network Value Based Contacting experience with 2-3 years Medicaid Network experience
• Must have Microsoft Office experience with intermediate to advanced Excel and PowerPoint skills
• 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
• Candidates are to reside within applicable State
• This is a work at home position, with ability to travel within the state to visit providers or to main office in Aetna Office Locations applicable to the Market

Preferred Qualifications

• Familiar with legal terms in the context of provider contracting
• Able to apply system thinking when managing multiple provider value-based initiatives
• Strong financial modeling background
• Education Bachelor’s degree or equivalent professional working experience.

Pay Range

The typical pay range for this role is: $75,400.00 - $182,549.00 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.

Benefits

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.

Company Culture

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. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.

Application Window

We anticipate the application window for this opening will close on: 10/29/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.