Strategic Healthcare Contract Negotiator

CVS Health; Sacramento (CA); On-site; USD 60,000 - 133,000; Full time

Job summary

CVS Health is seeking a Contract Manager in California to support contracting initiatives and data audits, helping to strengthen provider networks while meeting accessibility, compliance, quality, and financial goals.

The role handles contract review, building and auditing complex data, supports recruitment, and collaborates on negotiations to optimize network performance and cost management in a full-time setting.

Qualifications

• 5+ years of working knowledge of the healthcare industry, including competitor strategies, complex contracting options, financial and contracting arrangements, and regulatory requirements.
• 3+ years of experience in provider relationship management or related healthcare roles, with proven and proficient contract management skills.
• Strong communication, critical thinking, problem-resolution and interpersonal skills.
• Proficiency in Microsoft Office Suite (e.g., Excel, Word, PowerPoint, Outlook).

Responsibilities

• Negotiate, execute, review, and analyze contracts and/or handle dispute resolution and settlement negotiations with solo, small group, or local providers, including SCAs, LOAs, and PPAs.
• Manage contract performance in support of network quality, availability, and financial goals and strategies.
• Recruit providers to ensure attainment of network expansion and adequacy targets.
• Collaborate cross-functionally to contribute to provider compensation and pricing development activities and recommendations, submission of contractual information, and review and analysis of reports as part of negotiation and reimbursement modeling activities.
• Identify and make recommendations to manage cost issues and support cost saving initiatives and/or settlement activities.
• Provide network development, maintenance, and refinement activities and strategies in support of cross-market network management unit.
• Assist with design, development, management, and/or implementation of strategic network configurations, including integration activities.
• May optimize interaction with assigned providers and internal business partners to manage relationships and ensure provider needs are met.
• Ensure resolution of escalated issues related to claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.
• Interpret contractual requirements including federal and state regulations and NCQA.

Skills

Healthcare contracting

Provider relationship management

Communication skills

MS Office proficiency

Education

Bachelor's degree preferred

Tools

Microsoft Office Suite

Job description

CVS Health is seeking a Contract Manager in California to support contracting initiatives and data audits, helping to strengthen provider networks while meeting accessibility, compliance, quality, and financial goals.

The role handles contract review, building and auditing complex data, supports recruitment, and collaborates on negotiations to optimize network performance and cost management in a full-time setting.