National Provider Network Negotiations Manager

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

Job summary

CVS Health in the United States is seeking a contracts professional to negotiate, execute, review, and analyze provider contracts, and to deliver dispute resolution and settlements. You will ensure contract performance aligns with accessibility, quality, financial, and cost goals.

You will build relationships with physicians/providers and network teams, lead negotiation initiatives, forecast market changes, and mentor junior colleagues.

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 working relationships with physicians/providers and local network and patient management teams in the markets with Aetna.
• Establishes and implements programs and innovative initiatives for the organization to advance Contract Negotiations initiatives.
• Forecasts changes within the Contract Negotiations industry, conducts business impact assessments, and develops modification strategies with the aid of process improvement methodologies.
• Integrates cross-functional collaboration to contribute to provider compensation and pricing development activities and recommendations for negotiations and reimbursement modeling activities.
• Determines recommendations to manage cost issues and support cost-saving initiatives and settlement activities.
• Assists in the management of network development, maintenance, and refinement activities and strategies in support of cross-market network management units.
• Coaches more junior colleagues in techniques, processes, and responsibilities.
• Other duties and responsibilities as assigned by manager.

Skills

Provider contracting

Claims management

Patient management

Education

Bachelor's degree

Tools

ACAS

HRP

SCM

Smart Front End

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Contract Inquiry

Job description

CVS Health in the United States is seeking a contracts professional to negotiate, execute, review, and analyze provider contracts, and to deliver dispute resolution and settlements. You will ensure contract performance aligns with accessibility, quality, financial, and cost goals.

You will build relationships with physicians/providers and network teams, lead negotiation initiatives, forecast market changes, and mentor junior colleagues.