Provider Contracts & Network Negotiations Lead

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

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health in the United States is seeking a Contract Negotiator to lead negotiation, execution, and analysis of contracts, and to deliver dispute resolution and settlements with providers, ensuring performance aligns with accessibility, quality, and cost goals.

You will build relationships with physicians and local network teams, implement program initiatives for contract negotiations, and collaborate on reimbursement modeling with cross-functional teams.

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.

Education

Bachelor's degree preferred

Job description

CVS Health in the United States is seeking a Contract Negotiator to lead negotiation, execution, and analysis of contracts, and to deliver dispute resolution and settlements with providers, ensuring performance aligns with accessibility, quality, and cost goals.

You will build relationships with physicians and local network teams, implement program initiatives for contract negotiations, and collaborate on reimbursement modeling with cross-functional teams.