Strategic Provider Contract Manager

CVS Health; Virginia (IL); Hybrid; USD 54,000 - 159,000; Full time

Benefits offered by this job

Benefits package

Bonus eligibility

Job summary

CVS Health is seeking a contract negotiator to lead the negotiation, execution, and analysis of contracts with providers, ensuring alignment with accessibility, quality, and cost goals.

The role involves building relationships with physicians/providers and local network teams, developing programs for negotiations, forecasting industry changes, and guiding cost-saving initiatives. 40-hour weeks, full-time with a comprehensive benefits package.

Qualifications

• 5+ years of provider contracting, claims management, or patient management experience.
• 5+ years working in a Claims environment.
• 5+ years with ACAS and HRP claim platforms, products, and benefits.

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.

Skills

Provider contracting

Claims management

Patient management

Education

Bachelor's degree

Tools

ACAS

HRP

Job description

CVS Health is seeking a contract negotiator to lead the negotiation, execution, and analysis of contracts with providers, ensuring alignment with accessibility, quality, and cost goals.

The role involves building relationships with physicians/providers and local network teams, developing programs for negotiations, forecasting industry changes, and guiding cost-saving initiatives. 40-hour weeks, full-time with a comprehensive benefits package.