Network Contracts & Negotiations Lead

CVS Health; Wyoming (OH); Hybrid; USD 54,000 - 159,000; Full time

Benefits offered by this job

Bonus program

Comprehensive benefits

Job summary

CVS Health is seeking a Senior Contract Negotiations professional to construct, analyze, and resolve contracts with providers, ensuring performance aligns with quality and cost goals. The role focuses on payer-provider relations across markets and driving innovative negotiation programs.

You will forecast industry changes, support pricing and reimbursement modeling, and mentor junior staff while collaborating with cross-functional teams to optimize network value.

Qualifications

• 5+ years of provider contracting, claims management, or patient management experience.
• 5+ years working with/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.
• Establishes and implements programs and innovative initiatives for contract negotiations.
• Forecasts changes in the contract negotiations industry and develops modification strategies.
• Integrates cross-functional collaboration for provider compensation and pricing development.
• Manages cost issues and supports cost-saving settlement activities.
• Assists in network development, maintenance, and refinements for cross-market units.
• Coaches junior colleagues in techniques and processes.
• Other duties as assigned by manager.

Skills

Provider contracting

Claims management

ACAS/HRP systems

Education

Bachelor's degree

Tools

Aetna SCM

Smart Front End

Rate Inquiry

Contract Inquiry

Job description

CVS Health is seeking a Senior Contract Negotiations professional to construct, analyze, and resolve contracts with providers, ensuring performance aligns with quality and cost goals. The role focuses on payer-provider relations across markets and driving innovative negotiation programs.

You will forecast industry changes, support pricing and reimbursement modeling, and mentor junior staff while collaborating with cross-functional teams to optimize network value.