Strategic Network Contracts Manager

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

Job summary

CVS Health in the United States is seeking a Contract Negotiator to lead negotiation, execution, review and analysis of contracts, and to deliver dispute resolution with providers. You will ensure contract performance aligns with accessibility, quality, financial, and cost goals.

The role requires 5+ years in provider contracting and claims management, with familiarity with ACAS and HRP platforms, and a collaborative approach with cross-functional teams across networks.

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

Contract negotiation

Dispute resolution

Provider relations

Claims management

Education

Bachelor's degree

Tools

ACAS

HRP

SCM

Smart Front End

Rate Inquiry

Contract Inquiry

Job description

CVS Health in the United States is seeking a Contract Negotiator to lead negotiation, execution, review and analysis of contracts, and to deliver dispute resolution with providers. You will ensure contract performance aligns with accessibility, quality, financial, and cost goals.

The role requires 5+ years in provider contracting and claims management, with familiarity with ACAS and HRP platforms, and a collaborative approach with cross-functional teams across networks.