Provider Contract Negotiation Manager

4062 Aetna Resources, LLC; Kentucky; Hybrid; USD 60,000 - 133,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Retirement plan

Paid time off

Job summary

CVS Health is seeking a remote contract negotiator responsible for constructing negotiation, execution, review, and analysis of provider contracts. It delivers dispute resolution and settlements to ensure contract performance aligns with accessibility, compliance, quality, financial, and cost goals.

In this role you will negotiate single case agreements, collaborate with internal teams, mentor junior colleagues, and support cost-saving initiatives across markets.

Qualifications

• 5+ years in provider contracting or claims management.
• 2+ years in claims operations or related environment.
• 1-2 years with ACAS and HRP platforms, claims products, and benefits.

Responsibilities

• Negotiate single case agreements for episodes of care on a pre-service basis.
• Analyze forecast changes and develop impact assessments with process improvements.
• Recommend cost management and settlement strategies to reduce costs.
• Build relationships with physicians/providers and local networks.
• Coach junior colleagues and share best practices.
• Collaborate with internal teams to support negotiations and outcomes.

Skills

Provider contracting

Claims management

Cross-functional collaboration

Mentoring

Education

Bachelor's degree in a related field

Tools

ACAS/HRP platforms

Smart Front End

MedCompass

RUMBA applications

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. This remote position constructs negotiation, execution, review, and analysis of contracts. Delivers dispute resolution and settlement negotiations with providers. Ensures contract performance aligns with accessibility, compliance, quality, financial, and cost goals.

What you will do

• Negotiate single case agreements for episodes of care on a pre-service basis.
• Participation/engagement of looking at forecast changes within the Contract Negotiations industry, development of business impact assessments, and modification strategies with the aid of process improvement methodologies.
• Determines recommendations to manage cost issues and support cost-saving initiatives and settlement activities.
• Develop, maintain, and enhance working relationships with physicians/providers and local network and patient management teams in the markets within Aetna.
• Coaches more junior colleagues in techniques, processes, and responsibilities.
• Collaborates cross-functionally with internal teams to support and manage negotiations, ensuring alignment and successful outcomes.

Required Qualifications

• 5+ years of experience in provider contracting, claims management, or patient management.
• 2+ years of experience in claims operations or a related claims management environment.
• 1-2 years of experience working with ACAS and HRP claims platforms, products, and benefits, as well as patient management, provider relations, or claims management.

Preferred Qualifications

• Knowledge/experience with National Advantage Program within Aetna.
• Working knowledge of Aetna systems and tools, including Smart Front End, ASD, HRP, MedCompass, and RUMBA applications (EPDB, EWMP, Rate Inquiry, and Contract Inquiry).

Anticipated Weekly Hours

40

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.

Our people fuel our future

Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

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. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments.

Application Closing Date

We anticipate the application window for this opening will close on: 11/17/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Our Work Experience

Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.