Senior Provider Contract & Network Manager

CVS Health; West Virginia; Híbrido; USD 54.000 - 159.000; Jornada completa

Descripción de la vacante

CVS Health is seeking a Contract Negotiator to lead negotiations with providers, align contract performance with accessibility and quality goals, and support cost management initiatives. You will collaborate with local network and patient management teams to drive reimbursement modeling and dispute resolution.

The role requires 5+ years in contracting or claims, a Bachelor's degree, and experience with ACAS/HRP systems.

Formación

• 5+ years of provider contracting, claims management, or patient management experience.
• 5+ years in a Claims environment.
• 5+ experience that includes ACAS and HRP claim platforms, products, and benefits; patient management, provider relations, or claims management.
• Bachelor's degree preferred.

Responsabilidades

• 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 and develops modification strategies with process improvement methods.
• Integrates cross-functional collaboration to contribute to provider compensation and pricing development activities and recommendations for negotiations and reimbursement modeling activities.
• Determine recommendations to manage cost issues and support cost-saving initiatives and settlement activities.
• Assist in the management of network development, maintenance, and refinement activities and strategies in support of cross-market network management units.
• Coach more junior colleagues in techniques, processes, and responsibilities.
• Other duties and responsibilities as assigned by manager.

Conocimientos

Provider contracting

Claims management

Patient management

Educación

Bachelor's degree preferred

Herramientas

ACAS

HRP claim platforms

SCM

Smart Front End

Rate Inquiry

Contract Inquiry

Descripción del empleo

CVS Health is seeking a Contract Negotiator to lead negotiations with providers, align contract performance with accessibility and quality goals, and support cost management initiatives. You will collaborate with local network and patient management teams to drive reimbursement modeling and dispute resolution.

The role requires 5+ years in contracting or claims, a Bachelor's degree, and experience with ACAS/HRP systems.