Strategic Provider Contract & Network Manager

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

Job summary

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

The role emphasizes cross-functional collaboration on provider compensation, pricing, and reimbursement modeling, with focus on cost-saving settlements and network development activities.

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.
• Experience with Aetna systems (SCM, Smart Front End, Rate Inquiry, Contract Inquiry).

Responsibilities

• Constructs negotiation, execution, review, and analysis of contracts.
• Delivers dispute resolution and settlement negotiations with providers.
• Ensures contract performance aligns with accessibility, compliance, quality, financial, and cost goals.
• Integrates cross-functional collaboration to contribute to provider compensation and pricing development activities and recommendations.
• 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.

Skills

Provider contracting

Claims management

Patient management

Education

Bachelor's degree

Job description

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

The role emphasizes cross-functional collaboration on provider compensation, pricing, and reimbursement modeling, with focus on cost-saving settlements and network development activities.