Manager, Provider Contracts & Network Strategy

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

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings

Job summary

CVS Health is seeking an experienced contracts professional to construct, execute, review, and analyze agreements with providers. The role includes delivering dispute resolution and settlement negotiations, and ensuring contract performance aligns with accessibility, compliance, quality, financial, and cost goals.

You will build relationships with physicians, providers, and local network teams, drive negotiation initiatives, and contribute to cost-saving strategies while mentoring junior

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

• Develop, maintain, and enhance relationships with physicians/providers and local network and patient management teams.
• Establish programs and initiatives for Contract Negotiations.
• Forecast changes and develop modification strategies using process improvement methods.
• Collaborate cross-functionally on provider compensation and pricing development for negotiations and modeling.
• Recommend actions to manage costs and support settlement activities.
• Assist in network development, maintenance, and refinement activities.
• Mentor junior colleagues in techniques and responsibilities.
• Perform other duties as assigned by manager.

Skills

Provider contracting

Claims management

Patient management

ACAS & HRP platforms

Education

Bachelor's degree preferred

Tools

SCM (Aetna)

Smart Front End

Rate Inquiry

Contract Inquiry

Job description

CVS Health is seeking an experienced contracts professional to construct, execute, review, and analyze agreements with providers. The role includes delivering dispute resolution and settlement negotiations, and ensuring contract performance aligns with accessibility, compliance, quality, financial, and cost goals.

You will build relationships with physicians, providers, and local network teams, drive negotiation initiatives, and contribute to cost-saving strategies while mentoring junior