Strategic Provider Contract Negotiations Manager

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

Benefits offered by this job

Comprehensive benefits

Bonus eligibility

Job summary

CVS Health is seeking a senior professional to construct negotiation, execution, review, and analysis of contracts and to deliver dispute resolution with providers. The role ensures contract performance aligns with accessibility, compliance, quality, financial, and cost goals.

You will develop relationships with physicians/providers and local network teams in markets with Aetna, implement innovative contract initiatives, and forecast changes in the industry to drive cost-saving strategies and

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

Provider contracting

Claims management

Patient management

ACAS/HRP platforms

Education

Bachelor's degree (preferred)

Tools

Aetna systems (SCM, Smart Front End, Rate Inquiry, Contract Inquiry)

Job description

CVS Health is seeking a senior professional to construct negotiation, execution, review, and analysis of contracts and to deliver dispute resolution with providers. The role ensures contract performance aligns with accessibility, compliance, quality, financial, and cost goals.

You will develop relationships with physicians/providers and local network teams in markets with Aetna, implement innovative contract initiatives, and forecast changes in the industry to drive cost-saving strategies and