Provider Network Contracts Lead

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

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings

Wellness programs

Bonus program

Job summary

CVS Health is seeking a seasoned professional to construct negotiation, execution, review, and analysis of contracts with a focus on accessibility, compliance, and cost goals. You will deliver dispute resolution and settlement negotiations with providers to ensure contract performance aligns with organizational aims.

You will develop programs for contract negotiations, forecast industry changes, and collaborate cross-functionally on provider compensation and pricing.

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.
• Establishes programs for the organization to advance Contract Negotiations initiatives.
• Forecasts changes within the Contract Negotiations industry and develops modification strategies.
• Integrates cross-functional collaboration for provider compensation and pricing development.
• Manages network development, maintenance, and refinement activities; coaches junior colleagues.

Skills

Provider contracting

Claims management

Patient management

ACAS/HRP platforms

Cross-functional collaboration

Education

Bachelor's degree

Tools

Aetna SCM

Smart Front End

Rate Inquiry

Contract Inquiry

Job description

CVS Health is seeking a seasoned professional to construct negotiation, execution, review, and analysis of contracts with a focus on accessibility, compliance, and cost goals. You will deliver dispute resolution and settlement negotiations with providers to ensure contract performance aligns with organizational aims.

You will develop programs for contract negotiations, forecast industry changes, and collaborate cross-functionally on provider compensation and pricing.