Senior Manager, Provider Contract Negotiations Job at CVS Health (Work at Home)

Job Description

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.

Job Responsibility

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.

Requirements

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).
Bachelor's Degree or equivalent combination of education and experience

Nice to have

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.

What we offer

medical
dental
vision coverage
paid time off
retirement savings options
wellness programs
bonus, commission or short-term incentive program
equity award program

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Senior Manager, Provider Contract Negotiations

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