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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. Strong preference for candidate to sit in the Pacific Northwest, however would be open to candidates in the Pacific Time Zone and Mountain Time Zone. This is an individual contributor.
Job Responsibility:
Developing strategic partnerships to ensure Aetna has market leading discount and cost positions and high value, competitive networks
Designing conceptual models, initiative planning, and negotiating high value contracts with the most complex and challenging hospital systems, integrated delivery systems and large groups
Working cross functionally to ensure consistency with all contracting strategies and meeting and exceeding accessibility, quality, compliance, and financial goals and cost initiatives
Building strong relationships with providers as well as developing and executing contract strategies and yield market leading discount and cost positions for Aetna
Negotiation and management of various value based payment models and management of contract performance associated with these models with key focus on provider engagement
Recruit providers as needed to ensure attainment of network expansion and adequacy targets
Accountable for cost arrangements within defined groups
Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities
Responsible for identifying and managing cost issues and collaborating cross functionally to execute significant cost saving initiatives
Represents company with high visibility constituents, including customers and community groups
Promotes collaboration with internal partners
Evaluates, helps formulate, and implements the provider network strategic plans to achieve contracting targets and manage medical costs through effective provider contracting to meet state contract and product requirements
Collaborates with internal partners to assess effectiveness of tactical plan in managing costs
Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information
Helps mentor and develop others within the department by providing shadowing opportunities and acting as a subject matter expert
Requirements:
A minimum of 8 years related experience and expert level negotiation skills with successful track record negotiating contracts with large or complex provider systems
Demonstrated knowledge of value-based contracting structures, including negotiation and implementation of agreements that align cost, quality, and performance outcomes across stakeholders
Experience with Medicare, Commercial contracting and various reimbursement methodologies
Demonstrated ability to build, manage, and grow strategic relationships that advance long-term organizational goals
Experience presenting complex information to groups in a clear, concise, and persuasive manner, adapting style and content to audience needs
Bachelor’s Degree preferred or equivalent combination of education and experience
Nice to have:
Proven working knowledge of provider financial issues and competitor strategies
Strong preference to have relationships with large health systems in Oregon, Washington and Idaho
What we offer:
Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching