Strategic Healthcare Contracts Manager

4062 Aetna Resources, LLC; Oregon; Hybrid; USD 60,000 - 133,000; Full time

Job summary

CVS Health is seeking an experienced Contract Manager to support contracting initiatives and data audits for a robust provider network. You will review, build, and audit complex contracts while collaborating on negotiations with healthcare providers to meet accessibility, quality, and financial goals.

You will manage contract performance, recruit providers, and work cross-functionally on compensation, pricing, and reimbursement modeling.

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

• Negotiates, executes, reviews, and analyzes contracts and/or handles dispute resolution and settlement negotiations with solo, small group, or local providers, including SCAs, LOAs, and PPAs.
• Manages contract performance in support of network quality, availability, and financial goals and strategies.
• Recruits providers to ensure attainment of network expansion and adequacy targets.
• Collaborates cross-functionally to contribute to provider compensation and pricing development activities and recommendations, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities.
• Responsible for identifying and making recommendations to manage cost issues and supporting cost saving initiatives and/or settlement activities.
• Provides network development, maintenance, and refinement activities and strategies in support of cross-market network management unit.
• Assists with the 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.
• Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.
• Interprets contractual requirements including federal and state regulations and NCQA.

Skills

Healthcare industry knowledge

Provider relationship management

Communication

Problem solving

Education

Bachelor's degree preferred

Tools

Microsoft Office

Job description

CVS Health is seeking an experienced Contract Manager to support contracting initiatives and data audits for a robust provider network. You will review, build, and audit complex contracts while collaborating on negotiations with healthcare providers to meet accessibility, quality, and financial goals.

You will manage contract performance, recruit providers, and work cross-functionally on compensation, pricing, and reimbursement modeling.