Contract Negotiation Manager - KY Medicaid

CVS Health•Nicholasville, KY

3d•$54,300 - $119,340•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.

Requirements

3-5 years experience with provider contract negotiations or provider relations experience
Proven working knowledge of the Medicaid service line, preferably the state of Kentucky program.
Must reside in the state of Kentucky

Nice To Haves

Medicaid provider relations or claims payment expertise.
Proven and proficient managed care network negotiating skills.
Strong communication, critical thinking, problem resolution and interpersonal skills
Adept at execution and delivery (planning, delivering, and supporting) skills
Adept at business intelligence
Adept at collaboration and teamwork
Adept at growth mindset (agility and developing yourself and others) skills

Responsibilities

Reviews, analyzes, negotiates and executes Medicaid contracts.
Leads reimbursement dispute resolution and settlement negotiations with provider groups for the Medicaid line of business.
Completes all activities related to standard contract intake and implementation.
Manages contract performance in support of network quality, availability, and financial goals and strategies.
Recruits providers as needed to ensure attainment of network expansion and adequacy targets.
Collaborates cross-functionally to contribute to provider compensation and pricing development activities and recommendations, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities.
Responsible for identifying and making recommendations to manage cost issues and supporting cost saving initiatives and/or settlement activities.
Provides network development, maintenance, and refinement activities and strategies as applicable.
Provides contract expertise and support to other internal business partners/units related to contract setup accuracy, language interpretation, claims payment and/or other matters requiring network contracting expertise.
Leads and/or participates in special projects.