Provider Contract & Network Management Lead

CVS Health; New Hampshire; Hybrid; USD 54,000 - 159,000; Full time

Benefits offered by this job

Medical insurance

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health seeks a seasoned contract negotiator to construct, execute, review and analyze provider contracts. You will lead dispute resolution and ensure performance aligns with accessibility, quality, financial, and cost goals.

You will collaborate cross-functionally to support provider compensation, pricing development, and reimbursement modeling. The role involves mentoring juniors and shaping network development strategies to optimize across markets.

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

ACAS and HRP platforms

Education

Bachelor's degree preferred

Tools

Aetna SCM

Smart Front End

Rate Inquiry

Contract Inquiry

Job description

CVS Health seeks a seasoned contract negotiator to construct, execute, review and analyze provider contracts. You will lead dispute resolution and ensure performance aligns with accessibility, quality, financial, and cost goals.

You will collaborate cross-functionally to support provider compensation, pricing development, and reimbursement modeling. The role involves mentoring juniors and shaping network development strategies to optimize across markets.