Provider Contract & Network Negotiations Lead

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

Benefits offered by this job

Comprehensive benefits

40-hour work week

Job summary

CVS Health in Utah seeks a skilled Contract Negotiator to lead negotiation, execution, and analysis of contracts with providers. You will deliver dispute resolution and ensure contract performance aligns with accessibility, quality, financial, and cost goals.

Responsibilities include developing relationships with physicians/providers and local networks, implementing initiatives for contract negotiations, forecasting industry changes, and mentoring junior colleagues.

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 relationships with physicians/providers and local network and patient management teams in the markets with Aetna.
• Establishes and implements programs and initiatives for Contract Negotiations.
• Forecasts changes within the Contract Negotiations industry and develops modification strategies.
• Integrates cross-functional collaboration for provider compensation and pricing development for negotiations and reimbursement modeling.
• Determines recommendations to manage cost issues and support settlements.
• Assists in network development, maintenance, and refinement activities and strategies.
• Coaches junior colleagues in techniques, processes, and responsibilities.

Skills

Provider contracting

Claims management

Patient management

Education

Bachelor's degree preferred

Tools

Aetna systems

Job description

CVS Health in Utah seeks a skilled Contract Negotiator to lead negotiation, execution, and analysis of contracts with providers. You will deliver dispute resolution and ensure contract performance aligns with accessibility, quality, financial, and cost goals.

Responsibilities include developing relationships with physicians/providers and local networks, implementing initiatives for contract negotiations, forecasting industry changes, and mentoring junior colleagues.