Network Contracts & Negotiations Manager

CVS Health

Minnesota

Hybrid

USD 54,000 - 159,000

Full time

3 days ago

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Job summary

CVS Health is seeking an experienced professional to construct negotiation, execution, review, and analysis of contracts and to deliver dispute resolution with providers. You will ensure contract performance aligns with accessibility, compliance, quality, financial, and cost goals.

Role requires 5+ years in provider contracting or claims management, and familiarity with ACAS/HRP claim platforms. Bachelor's degree preferred.

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

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.