Senior Provider Contract & Network Manager

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

Benefits offered by this job

Medical insurance

Dental coverage

Vision coverage

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health in Tennessee seeks a Contract Negotiations professional to construct negotiation, execution, review, and analysis of contracts with providers. The role delivers dispute resolution and settlement negotiations, ensuring alignment with accessibility, quality, financial, and cost goals.

You will build relationships with physicians/providers and local network and patient management teams in markets with Aetna and implement innovative initiatives to advance Contract Negotiations.

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

ACAS HRP platforms

Patient management

Provider relations

Education

Bachelor's degree (preferred)

Job description

CVS Health in Tennessee seeks a Contract Negotiations professional to construct negotiation, execution, review, and analysis of contracts with providers. The role delivers dispute resolution and settlement negotiations, ensuring alignment with accessibility, quality, financial, and cost goals.

You will build relationships with physicians/providers and local network and patient management teams in markets with Aetna and implement innovative initiatives to advance Contract Negotiations.