Payor Relations & Contracting Manager

CVS Health

Kentucky

Hybrid

USD 60,000 - 133,000

Full time

5 days ago

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Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Other resources

Job summary

CVS Health is seeking a Manager of Contract Negotiation to develop and maintain strategic relationships with physician partners across the Northern Ohio market, leading contract management and provider relations initiatives that support Commercial and Medicare lines.

You will design and review provider contracts, monitor performance for accessibility, quality and cost objectives, mentor teammates, and collaborate cross-functionally to optimize reimbursement models and cost-saving strategies.

Qualifications

5 years of experience leading or supporting operational functions within healthcare administration or health insurance environments.
3+ years managing provider relationships and overseeing contract management functions.
Proficiency in Microsoft Word, Excel, and PowerPoint.

Responsibilities

Lead the development and execution of innovative programs to advance contract negotiation initiatives across the organization.
Anticipate industry changes, evaluate their impact, and formulate strategic responses.
Design and implement systems to recruit providers, supporting network expansion and adequacy goals.
Conduct competitive analyses to inform reimbursement strategies.
Foster cross-functional collaboration to enhance provider compensation methodologies and analyze financial impacts of reimbursement models.
Recommend strategies to address cost challenges and drive cost-saving initiatives and settlement activities.
Support network development, maintenance, and optimization to achieve company and market objectives.
Mentor colleagues on best practices, processes, and responsibilities to strengthen team capabilities.

Skills

Healthcare operations experience

Provider relations experience

Contract management experience

Stakeholder collaboration

Analytical problem solving

Education

Bachelor's degree

Tools

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

Job description

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

Position Summary

This is an individual contributor role.

The Manager of Contract Negotiation develops and maintains strategic relationships with physician partners across the Northern Ohio market, leading contract management and provider relations initiatives that support Commercial and Medicare lines of business.

In addition to managing these relationships, the Manager develops, reviews, analyzes, and executes provider contracts. They ensure proper implementation of negotiated agreements and monitor contract performance to align with accessibility, compliance, quality, financial, and cost objectives.

Key Responsibilities

Lead the development and execution of innovative programs to advance contract negotiation initiatives across the organization.
Anticipate industry changes, evaluate their impact, and formulate strategic responses.
Design and implement systems to recruit providers, supporting network expansion and adequacy goals.
Conduct competitive analyses to inform reimbursement strategies.
Foster cross-functional collaboration to enhance provider compensation methodologies and analyze financial impacts of reimbursement models.
Recommend strategies to address cost challenges and drive cost-saving initiatives and settlement activities.
Support network development, maintenance, and optimization to achieve company and market objectives.
Mentor colleagues on best practices, processes, and responsibilities to strengthen team capabilities.

Required Qualifications

5 years of experience leading or supporting operational functions within healthcare administration or health insurance environments.
3+ years managing provider relationships and overseeing contract management functions.
Demonstrated ability to partner with internal and external stakeholders to identify root causes, develop solutions, and drive issue resolution within established timelines.
Proficiency in Microsoft Word, Excel, and PowerPoint.

Preferred Qualifications

3+ years experience with provider contract negotiation or provider relations experience
Experience with EPDB (Enterprise Provider Database, SCM (Strategic Contract Manager), and Provider Data Management.
Experience with Commercial and Medicare lines of business.
Exceptional written and verbal communication skills, particularly with external stakeholders.
Strong critical thinking, problem-solving, and interpersonal skills.
Candidates residing in Ohio are strongly preferred.

Education

Bachelor's degree or equivalent combination of education and professional work experience.

Anticipated Weekly Hours

Time Type

Full time

Pay Range

The typical pay range for this role is:

$60,300.00 - $132,600.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.