We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Position Summary
Designs, develops, contracts, maintains and enhances relationships with facilities, physicians and ancillary providers which serve as contractual networks of care for members. Manages and maintains relationships with healthcare providers within a network by negotiating contracts, evaluating provider performance, resolving issues or disputes, identifying network expansion opportunities, and collaborating with internal and external stakeholders.
Establishes relationships with network providers, fostering open communication and collaboration to ensure a strong network partnership.
Analyzes network provider performance and quality indicators, conducting regular assessments and audits to ensure compliance with contractual obligations and service level agreements.
Addresses and resolves escalated issues and concerns raised by network providers, demonstrating a proactive and customer-centric approach to problem-solving.
Collaborates with network contracting teams to negotiate and establish contractual terms and conditions with network providers, ensuring alignment with organizational goals and objectives.
Develops tactical and operational plans to expand and enhance the network, working closely with business development teams to identify and onboard new providers in strategic areas.
Monitors and analyzes network data, including provider demographics and network adequacy metrics, to assess the effectiveness and efficiency of the network and make recommendations for improvements.
Collaborates with cross-functional teams, such as finance, operations, and customer service, to ensure effective coordination and alignment of network-related activities and initiatives.
Conducts regular meetings and performance reviews with network providers to review performance metrics, address concerns, and identify opportunities for improvement.
Stays updated on industry trends, regulatory changes, and market dynamics that may impact network provider relationships, and proactively communicates relevant information to internal stakeholders.
Required Qualifications
- Must reside in Arizona, Northern Arizona preferred.
- 5-7 years prior work experience in a healthcare environment.
- Ability to travel up to 50% of time within Arizona
- Adept at problem solving and decision making skills
- Adept at growth mindset (agility and developing yourself and others) skills
- Adept at execution and delivery (planning, delivering, and supporting) skills
Preferred Qualifications
- Certified Billing and Coding Specialist (CBCS) preferred.
Education
Bachelor's degree preferred/specialized training/relevant professional qualification or equivalent professional experience.
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$60,300.00 - $132,600.00This 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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Skills Required
- Must reside in Arizona (Northern Arizona preferred)
- 5-7 years prior work experience in a healthcare environment
- Ability to travel up to 50% of time within Arizona
- Adept at problem solving and decision making skills
- Adept at growth mindset (agility and developing yourself and others) skills
- Adept at execution and delivery (planning, delivering, and supporting) skills
- Bachelor's degree preferred or equivalent professional experience
- Certified Billing and Coding Specialist (CBCS)
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
