Contract Negotiation Manager

CVS Health • Washington, NV

7d • $60,300 - $132,600

About The Position

This individual-contributor role serves as a subject matter expert supporting contracting initiatives and data audits to enhance provider networks while meeting accessibility, compliance, quality, and financial goals. The Contract Manager reviews, builds, and audits complex contract and network data, supports provider recruitment, and collaborates on negotiations as needed. The role also supports network development and performance, provider relationships, compensation and pricing activities, cost management, and resolution of escalated provider issues.

Requirements

• At least 5 years of working knowledge of the healthcare industry, including competitor strategies, complex contracting options, financial and contracting arrangements, and regulatory requirements.
• At least 3 years of experience in provider relationship management or related healthcare roles, with proven and proficient contract management skills.
• Strong communication, critical-thinking, problem-resolution, and interpersonal skills.
• Proficiency in Microsoft Office Suite, including Excel, Word, PowerPoint, and Outlook.

Nice To Haves

• Candidates residing on the West Coast are strongly preferred.
• Bachelor's degree preferred, or a combination of professional work experience and education.

Responsibilities

• Negotiate, execute, review, and analyze contracts, and handle dispute resolution and settlement negotiations with solo, small group, or local providers, including SCAs, LOAs, and PPAs.
• Manage contract performance in support of network quality, availability, and financial goals and strategies.
• Recruit providers to meet network expansion and adequacy targets.
• Collaborate cross-functionally on provider compensation and pricing development activities and recommendations, submission of contractual information, and review and analysis of reports for negotiation and reimbursement modeling.
• Identify and recommend ways to manage cost issues and support cost-saving initiatives and settlement activities.
• Conduct network development, maintenance, and refinement activities and strategies for the cross-market network management unit.
• Assist with the design, development, management, and implementation of strategic network configurations, including integration activities.
• Optimize interactions with assigned providers and internal business partners to manage relationships and ensure provider needs are met.
• Resolve escalated issues involving claims payment, contract interpretation and parameters, and accuracy of provider contract or demographic information.
• Interpret contractual requirements, including federal and state regulations and NCQA.

Benefits

• Medical coverage
• Dental coverage
• Vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources supporting colleagues' physical, emotional, and financial well-being, based on eligibility
• Eligibility for a CVS Health bonus, commission, or short-term incentive program

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level