National Network Contract & Provider Relations Manager

CVS Health; Wisconsin; Híbrido; USD 54 000 - 159 000; Tempo integral

Resumo da oferta

CVS Health in Wisconsin is seeking a seasoned Provider Contract Negotiator to lead negotiation, execution, review, and settlement discussions with providers. You will ensure contract performance aligns with access, quality, financial and cost goals.

The role emphasizes cross-functional collaboration with physicians and network teams, driving innovative contracts and cost-saving initiatives, and mentoring junior colleagues.

Qualificações

• 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.
• Experience with Aetna systems (SCM, Smart Front End, Rate Inquiry, Contract Inquiry)
• Bachelor's degree preferred or a combination of professional work experience and education.

Responsabilidades

• Constructs negotiation, execution, review, and analysis of contracts.
• Delivers dispute resolution and settlement negotiations with providers.
• Forecasts changes within the Contract Negotiations industry and develops modification strategies.
• Integrates cross-functional collaboration to contribute to provider compensation and pricing development.
• Assists in network development, maintenance, and refinement activities and strategies.
• Coaches more junior colleagues in techniques, processes, and responsibilities.

Conhecimentos

Provider contracting

Claims management

ACAS/HRP platforms

Provider relations

Formação académica

Bachelor's degree

Ferramentas

SCM (Aetna)

Smart Front End

Rate Inquiry

Contract Inquiry

Descrição da oferta de emprego

CVS Health in Wisconsin is seeking a seasoned Provider Contract Negotiator to lead negotiation, execution, review, and settlement discussions with providers. You will ensure contract performance aligns with access, quality, financial and cost goals.

The role emphasizes cross-functional collaboration with physicians and network teams, driving innovative contracts and cost-saving initiatives, and mentoring junior colleagues.