Strategic Network Contracts Lead

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

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a seasoned Contracts professional to lead negotiation, execution, review, and analysis of contracts with providers. You will drive dispute resolution, cost-saving initiatives, and ensure alignment with accessibility, quality, and financial goals.

You will build relationships with physicians, providers, and local teams in markets aligned with Aetna, implement innovative initiatives, and forecast industry changes to influence negotiation strategies and reimbursement models.

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.
• Establishes and implements programs and initiatives for contract negotiations.
• Forecasts changes in the contract negotiations industry and develops modification strategies.
• Integrates cross-functional collaboration to contribute to provider compensation and pricing development for negotiations.
• Assists in cost management, settlements, and cost-saving initiatives.
• Support network development and refine strategies in cross-market units; coach junior colleagues.

Skills

Provider contracting

Claims management

Patient management

ACAS/HRP platforms

Cross-functional collaboration

Education

Bachelor's degree

Tools

SCM (Aetna system)

Smart Front End

Rate Inquiry

Contract Inquiry

Job description

CVS Health is seeking a seasoned Contracts professional to lead negotiation, execution, review, and analysis of contracts with providers. You will drive dispute resolution, cost-saving initiatives, and ensure alignment with accessibility, quality, and financial goals.

You will build relationships with physicians, providers, and local teams in markets aligned with Aetna, implement innovative initiatives, and forecast industry changes to influence negotiation strategies and reimbursement models.