Contract Negotiator Manager - Providers

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

• Recruits providers as needed to ensure network adequacy and achievement of network expansion goals.

• Negotiates contracts with health care providers using pre-determined internal guidelines and financial standards.
• Uses various sources of competitive intel to negotiate best in market discounts. 

• Develops rate proposals and performs financial analyses to ensure that results are within pre-determined targets.
• Negotiates contract language in accordance with Aetna standards, engaging other departments as needed for review and approval of contract terms outside the standards.

• Responsible for building contracts and amendments in contract management system in accordance with Aetna established guidelines, obtaining signatures, monitoring their progress post-signature, and verifying their accuracy post-release.

• Manages contract performance and works with various internal departments to address questions, issues, and activities related to execution, loading, and ongoing maintenance of provider contracts.
• Supports the negotiation and implementation of value-based contract relationships in support of business strategies.
• Manages relationships with key providers and ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.
• Negotiates settlements as needed.
• Responsible for identifying and making recommendations to manage cost issues and supporting cost saving initiatives.

Required Qualifications

• 3+ years of experience negotiating contracts with ancillary providers, facilities, physician groups, and IPAs, including contract language, development and analysis of rate proposals, identifying operational and financial improvement opportunities, and collection and analysis of competitive data and key financial metrics.  Uses competitive and financial data, as well as analysis detail, to negotiate favorable contracts.
• Understanding of common contract provisions, provider reimbursement methodologies and terms, and industry standard payment policies and practices.
• Understanding of provider financial issues, regulatory requirements, and competitor strategies.
• Demonstrates high proficiency with Microsoft Office suite applications (e.g., Outlook, Word, Excel, etc.)
• Detail-oriented with strong communication, analytical and negotiation skills.
• Able to manage expectations and maintain strong relationships, both internally and externally.
• Ability to build collaborative relationships with providers and work cross-functionally to resolve complex provider contract issues.
• Highly organized and able to successfully manage and prioritize multiple negotiations, issues, and other tasks to ensure completion and meet deadlines.

Preferred Qualifications

• Strong problem resolution and decision-making skills.
• Experience negotiating and/or managing hospital contracts.
• Experience negotiating and/or managing value-based contracts brings added value.

Education

• Bachelor’s Degree or equivalent combination of education and professional work experience.

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.