Provider Contract & Network Strategy Lead

ISHE; Northern (KY); Hybrid; USD 54,000 - 159,000; Full time

Benefits offered by this job

Medical insurance

Dental and vision coverage

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Contract Negotiations professional to lead complex provider contracts, ensure alignment with accessibility, compliance, and cost targets, and drive dispute resolution with providers.

The role emphasizes collaboration with networks, physicians, and local management teams to advance negotiations and pricing strategies, leveraging ACAS/HRP platforms where applicable.

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

• 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.
• 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.

Skills

Provider contracting

Claims management

Patient management

ACAS

HRP

Education

Bachelor's degree

Tools

SCM

Smart Front End

Rate Inquiry

Contract Inquiry

Job description

CVS Health is seeking a Contract Negotiations professional to lead complex provider contracts, ensure alignment with accessibility, compliance, and cost targets, and drive dispute resolution with providers.

The role emphasizes collaboration with networks, physicians, and local management teams to advance negotiations and pricing strategies, leveraging ACAS/HRP platforms where applicable.