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
The Senior Manager will manage the development of contracts and agreements with providers and delivery systems in conjunction with being accountable for designing conceptual models, initiative planning, and negotiating high value contracts with providers/facilities in accordance with company standards in order to maintain and enhance provider networks, while working cross functionally to ensure consistency with all contracting strategies and meeting and exceeding accessibility, quality, compliance, and financial goals and cost initiatives.
Responsibilities include:
- Negotiation and Execution: Conduct high-level review and analysis of dispute resolution and settlement negotiations of contracts with larger and more complex market/regional/national-based group/system providers. This includes but is not limited to large PCP groups, pediatricians, advanced specialist groups, hospital-based providers, ancillary providers, ambulatory surgical centers, behavioral health providers, etc. Ensure contracts align with company standards to maintain and enhance provider networks while meeting and exceeding accessibility, quality, financial goals, and cost initiatives.
- Provider Recruitment: Recruit providers as needed to achieve network expansion goals and meet regulatory and internal adequacy targets. Support health plan expansion initiatives and other contracting activities as required.
- Contract Management: Initiate, coordinate, and own the contracting activities to fulfillment, including receipt and processing of contracts and documentation. Conduct pre- and post-signature review of contracts and language modifications according to established policies.
- Auditing and Loading: Responsible for auditing, building, and loading contracts, agreements, amendments, and fee schedules in contract management systems per established policies.
- Research and Analysis: Conduct research, analysis, and audits to identify issues and propose solutions to protect data, contract integrity, and performance.
- Contract Performance Management: Manage contract performance and support the development and implementation of value-based contract relationships in alignment with business strategies.
- Cross-Functional Collaboration: Collaborate cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and review and analysis of reports as part of negotiation and reimbursement modeling activities.
- Subject Matter Expertise: Provide expert support for questions related to recruitment initiatives, contracting, provider issues/resolutions, related systems, and information contained. Share expertise and guidance with team members.
- Value-Based Contracting: Understand and manage value-based contracting and negotiations.
- Project Management: Manage high-level projects and recruitment initiatives with interdepartmental resources and cross-functional stakeholders.
- Provider Meetings: Coordinate and participate in provider-facing meetings, including but not limited to Joint Operating Committee meetings.
- Operational Support: Assist with operational activities such as database management and contract coordination.
- Data Management: Organize and transform information into comprehensible structures. Use data to predict trends in the customer base and the consumer population as a whole. Perform statistical analysis of data and visualize data in easy-to-understand formats, such as diagrams and graphs. Prepare reports and present findings to leadership.
- Provider Engagement: Engage with providers and efficiently move them through contracting processes to ensure network adequacy requirements are met.
Required Qualifications
- 7+ years of proven knowledge of standard provider contracts, terms, and language.
- 5+ years of negotiation skills while executing national, regional, or market-level strategies.
- In-depth understanding of the managed care industry and practices, as well as competitor strategies, practices, and financial/contracting arrangements.
- High proficiency with personal computers, including MS Office suite applications (e.g., Outlook, Word, Excel).
Preferred Qualifications
- Knowledge of managed care programs and related subject matter.
- Solid decision-making skills while executing national, regional, and market-level strategies.
- Strong critical thinking, problem resolution, and interpersonal skills.
- Ability to identify and capitalize on opportunities to support program delivery.
- Strong communication skills (written, verbal, and presentation).
- Ability to forge long-lasting relationships with providers.
- Highly organized and self-driven.
- Familiarity with EPDB, PRMS, Smart Front End, and Strategic Contract Manager systems.
Education
Bachelor’s Degree or equivalent combination of education and experience
Pay Range
The typical pay range for this role is:
$67,900.00 - $182,549.00
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.
Top Skills
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.
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