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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.
Job Responsibility:
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
Requirements:
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
Bachelor’s Degree or equivalent professional experience
Nice to have:
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