Contract Negotiation Manager (Tampa Bay Region)

CVS Health • Saint Petersburg, FL

28d

About The Position

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position SummaryThis is an individual contributor role.Manages contract performance and drives the development and implementation of value-based contract relationships in support of business strategies.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 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.May optimize interaction with assigned providers and internal business partners to facilitate relationships and ensure provider 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.

Requirements

• 3-5 years of related experience, proven and proficient managed care network negotiating skills.
• Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills with proven ability to negotiate and collaborate with providers and partners at all levels.
• Proven working knowledge of competitor strategies, complex contracting options, financial/contracting arrangements, and regulatory requirements.
• Highly organized and self-driven.
• Bachelor's degree and relevant training or work experience.

Nice To Haves

• Ability to forge meaningful, long-lasting relationships with providers.
• Knowledge of Medicare programs and related subject matter.
• Reside in the Southeast / Florida preferred.

Responsibilities

• Manages contract performance and drives the development and implementation of value-based contract relationships in support of business strategies.
• 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 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.
• May optimize interaction with assigned providers and internal business partners to facilitate relationships and ensure provider 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.

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Ambulatory Health Care Services
• Number of Employees: 5,001-10,000 employees