National Provider Contracts & Network Lead

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

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking an experienced professional to construct, negotiate, and review contracts with providers. The role focuses on ensuring contract performance aligns with accessibility, quality, financial, and cost goals in the Utah market.

The position requires 5+ years in contracting/claims, familiarity with ACAS and HRP platforms, and a Bachelor's degree (preferred). It offers a full-time schedule with robust benefits and bonus eligibility.

Qualifications

• 5+ years of provider contracting, claims management, or patient management experience.
• 5+ experience in a Claims environment.
• 5+ experience with 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.
• Establishes programs and initiatives for Contract Negotiations.
• Forecasts changes in the Contract Negotiations industry and develops modification strategies.
• Collaborates cross-functionally for provider compensation and pricing development for negotiations and reimbursement modeling.
• Assists in managing network development and refinement activities.
• Coaches junior colleagues in techniques and processes.
• Performs other duties as assigned.

Skills

Provider contracting

Claims management

Patient management

Analytical thinking

Negotiation

Education

Bachelor's degree

Tools

ACAS

HRP

SCM

Smart Front End

Rate Inquiry

Contract Inquiry

Job description

CVS Health is seeking an experienced professional to construct, negotiate, and review contracts with providers. The role focuses on ensuring contract performance aligns with accessibility, quality, financial, and cost goals in the Utah market.

The position requires 5+ years in contracting/claims, familiarity with ACAS and HRP platforms, and a Bachelor's degree (preferred). It offers a full-time schedule with robust benefits and bonus eligibility.