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Senior Provider Network Contracting

https://www.cvshealth.com/ Logo

CVS Health

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Location:
United States

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Category:
Health and Beauty

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Contract Type:
Employment contract

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Salary:

67900.00 - 165954.00 USD / Year
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Job Description:

The Senior Manager negotiates, executes, conducts high-level review and analysis, dispute resolution and/or settlement negotiations of contracts. Works with larger and more complex, market/regional/national-based groups/systems in accordance with company standards to maintain and enhance provider networks. This role is responsible for contracting and implementing fee-for-service and value-based agreements while collaborating with internal departments to improve performance and care quality. Additionally, the position involves leading initiatives related to cost and network expansion as well as managing provider compensation and pricing development activities.

Job Responsibility:

  • Negotiates, executes, conducts high-level review and analysis, dispute resolution and/or settlement negotiations of contracts
  • works with larger and more complex, market/regional/national-based groups/systems in accordance with company standards to maintain and enhance provider networks
  • responsible for contracting and implementing fee-for-service and value-based agreements with key physician groups, facilities, and ancillary providers
  • collaborates with Aetna and CVS departments to identify initiatives to improve physician performance and quality of care
  • recruits 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 review and analysis of reports as part of negotiation and reimbursement modeling activities

Requirements:

  • Minimum 5 years related experience and comprehensive level of negotiating with individual or complex provider systems or groups
  • proven working knowledge of provider financial issues and competitor strategies, large/complex contracting options, financial/contracting arrangements, and regulatory requirements
  • strong communication, critical thinking, problem resolution and interpersonal skills

Nice to have:

  • Commercial, individual exchange and Medicare experience
  • experience contracting with hospital systems and groups
  • advanced Excel experience including pivot tables and v-lookup function
What we offer:
  • Affordable medical plan options
  • a 401(k) plan including matching company contributions
  • employee stock purchase plan
  • no-cost wellness programs including screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
  • paid time off
  • flexible work schedules
  • family leave
  • dependent care resources
  • colleague assistance programs
  • tuition assistance
  • retiree medical access

Additional Information:

Job Posted:
May 13, 2025

Expiration:
June 21, 2025

Employment Type:
Fulltime
Work Type:
Remote work
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