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
This position supports Provider Contracting and Relationship Management for the Commercial and Medicare Segments with large and small health systems.
Negotiates, executes, reviews, and analyzes contracts and/or handles dispute resolution and settlement negotiations with providers in accordance with company standards to maintain and enhance provider networks while meeting and exceeding accessibility, compliance, quality, and financial goals and cost incentives
Manages contract performance in support of network quality, availability, and financial goals and strategies
Recruit providers as needed to ensure attainment of network expansion and adequacy targets
Collaborates cross -functionally to contribute to provider compensation and pricing development activities, recommendations, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities
Integrates cross-functional collaboration to contribute to provider compensation and pricing development activities and recommendations for negotiations and reimbursement modeling activities.
Identifying and making recommendations to manage cost issues and supporting cost saving initiatives and/or settlement activities
Provides ancillary network development, maintenance, and refinement activities and strategies in support of cross-market network management unit
Assists with the design, development, management, and/or implementation of strategic network configurations, including integration activities
Optimizes interaction with assigned providers and internal business partners to manage relationships and ensure providers needs are met
Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation, and parameters or accuracy of provider contract or demographic information
Coaches more junior colleagues in techniques, processes, and responsibilities.
Required Qualifications:
7+ years of Healthcare industry experience
5+ years of Provider Contract Network and Negotiation experience preferably.
Proven working knowledge of competitor strategies, complex contracting options, financial/contracting arrangements, and regulatory requirements
3+ years related experience Commercial HMO, PPO products knowledge
3+ years related experience Medicare and/or Medicaid products knowledge
Preferred Qualifications:
Intermediate knowledge of Microsoft Office, specifically Excel and PowerPoint
Location preference - Kansas, Missouri or surrounding area
A ready business acumen and the ability to balance and articulate competing priorities while making decisions
Strong and persuasive communication skills, especially written communications, with external stakeholders
Strong critical thinking, problem resolution and interpersonal skills
Adept at execution and delivery (planning, delivering, and supporting) skills
Adept at collaboration and teamwork
A growth mindset (agility and developing yourself and others) skills
Education
Bachelor’s Degree or equivalent professional experience
Pay Range
The typical pay range for this role is:
$67,900.00 - $165,954.00
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. This position also includes an award target in the company’s equity award program.
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.
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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.
