Contract Negotiation Manager - PA, DE, NY, NJ, MD, or Washington, DC

CVS Health•New York, MD

5d•$66,330 - $145,860•Remote

About The Position

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 Negotiates, executes, conducts high level review and analysis of dispute resolution and/or settlement negotiations of contracts with larger and more complex, market/regional/national based group/system providers including but not limited to individual and group behavioral health providers, etc. in accordance with company standards in order to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals and cost initiatives. Recruit providers as needed to ensure attainment of network expansion goals, achieve regulatory and/or internal adequacy targets. Support health plan with expansion initiatives or other contracting activities as needed Initiates, coordinates and owns contracting activities to fulfillment including receipt and processing of contracts and documentation and pre- and post-signature review of contracts and language modification according to Aetna’s established policies. Responsible for auditing, building, and loading contracts, agreements, amendments, and/or fee schedules in contract management systems per Aetna established policies. 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. Provides Subject Matter Expertise for questions related to recruitment initiatives, contracting, provider issues/resolutions, related systems and information contained. Understanding of Value-Based contracting and negotiations. Preparing reports and presenting to Network Management leadership Engage with providers and move quickly through contracting processes to ensure network adequacy standards are met.

Requirements

5+ years of healthcare experience in network contracting and provider relationship management.
3-5 years of solid negotiating and complex decision-making skills while executing national, regional, or market level strategies.
Demonstrated knowledge of the managed care industry, including reimbursement models, regulatory requirements, and contracting best practices.
Working knowledge of behavioral health topics related to managed care plans.
Advanced proficiency in Microsoft Office Suite, particularly Excel (e.g., data analysis, modeling, reporting) and PowerPoint (e.g., executive presentations).
Proven ability to build and maintain collaborative provider relationships and partner cross-functionally to resolve complex contract or network issues, with examples of successful issue resolution or stakeholder alignment.
Candidates must reside in PA, DE, NY, NJ, MD, or Washington, DC

Nice To Haves

Health plan experience supporting behavioral health provider networks.
General knowledge of reporting tools for contract financial analysis and modeling.
Demonstrated decision-making skills while executing national, regional and market level strategies.
Possess critical thinking, issue resolution and interpersonal skills.
Strong critical thinking and problem-solving abilities, with a track record of resolving complex issues and driving effective solutions.
Excellent interpersonal and communication skills, including the ability to clearly convey complex information both verbally and in writing to diverse stakeholders.

Responsibilities

Negotiates, executes, conducts high level review and analysis of dispute resolution and/or settlement negotiations of contracts with larger and more complex, market/regional/national based group/system providers including but not limited to individual and group behavioral health providers, etc. in accordance with company standards in order to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals and cost initiatives.
Recruit providers as needed to ensure attainment of network expansion goals, achieve regulatory and/or internal adequacy targets.
Support health plan with expansion initiatives or other contracting activities as needed
Initiates, coordinates and owns contracting activities to fulfillment including receipt and processing of contracts and documentation and pre- and post-signature review of contracts and language modification according to Aetna’s established policies.
Responsible for auditing, building, and loading contracts, agreements, amendments, and/or fee schedules in contract management systems per Aetna established policies.
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.
Provides Subject Matter Expertise for questions related to recruitment initiatives, contracting, provider issues/resolutions, related systems and information contained.
Understanding of Value-Based contracting and negotiations.
Preparing reports and presenting to Network Management leadership
Engage with providers and move quickly through contracting processes to ensure network adequacy standards are met.