Lead Provider Contract & Network Manager

CVS Health; New Hampshire; Hybrid; USD 54,000 - 159,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a seasoned professional to construct and analyze contracts, deliver dispute resolution with providers, and ensure performance aligns with accessibility and quality goals. The role focuses on advancing contract negotiations with cross-functional teams and optimizing cost and reimbursement strategies.

Experience with Aetna systems and a Bachelor’s degree are preferred. This full-time position offers comprehensive benefits and 40 hours weekly, with a pay range reflecting

Qualifications

• 5+ years of provider contracting, claims management, or patient management experience.
• 5+ experience working with/or in a Claims environment.
• 5+ experience that includes ACAS and HRP claim platforms, products, and benefits; patient management, provider relations, or claims management.

Responsibilities

• Constructs negotiation, execution, review, and analysis of contracts.
• Delivers dispute resolution and settlement negotiations with providers.
• Ensures contract performance aligns with accessibility, compliance, quality, financial, and cost goals.
• Establishes and implements programs and innovative initiatives for the organization to advance Contract Negotiations initiatives.
• Forecasts changes within the Contract Negotiations industry and develops modification strategies.

Skills

Provider contracting

Claims management

ACAS & HRP platforms

Education

Bachelor's degree

Tools

Aetna systems (SCM, Smart Front End, Rate Inquiry, Contract Inquiry)

Job description

CVS Health is seeking a seasoned professional to construct and analyze contracts, deliver dispute resolution with providers, and ensure performance aligns with accessibility and quality goals. The role focuses on advancing contract negotiations with cross-functional teams and optimizing cost and reimbursement strategies.

Experience with Aetna systems and a Bachelor’s degree are preferred. This full-time position offers comprehensive benefits and 40 hours weekly, with a pay range reflecting