Contract Negotiation Manager – Florida (Miami Dade, Broward, Palm Beach, and Treasure Coast)

CVS Health•Sunny Isles Beach, FL

1d•Onsite

About The Position

CVS Health is building a world of health around every individual, aiming to shape a more connected, convenient, and compassionate health experience. Colleagues are passionate, innovative, accountable, and prioritize safety and quality. The company's mission is to simplify health care one person, one family, and one community at a time. This individual contributor position is responsible for recruiting providers to ensure network adequacy and achieve network expansion goals. The role involves negotiating contracts with health care providers based on internal guidelines and financial standards, utilizing competitive intelligence to secure favorable discounts. Key tasks include developing rate proposals, performing financial analyses to meet targets, and negotiating contract language in adherence to Aetna standards, involving other departments for approval when necessary. The manager will build and amend contracts in the contract management system, obtain signatures, monitor progress, and verify accuracy post-release. This position also entails managing contract performance, collaborating with internal departments on execution and maintenance, and fostering relationships with key providers to resolve escalated issues related to claims, contract interpretation, or provider information. Additionally, the role involves negotiating settlements and identifying cost-saving opportunities.

Requirements

A minimum of five years of experience negotiating contracts with providers, facilities, and physician groups, including contract language development, analysis of rate proposals, identification of operational and financial improvement opportunities, and the collection and evaluation of competitive data and key financial metrics.
Uses detailed financial and market analysis to negotiate favorable contract terms.
Understanding of common contract provisions, provider reimbursement methodologies and terms, and industry standard payment policies and practices.
Understanding of provider financial issues, regulatory requirements, and competitor strategies.
Demonstrates high proficiency with Microsoft Office suite applications (e.g., Outlook, Word, Excel, etc.)
Ability to build collaborative relationships with providers and work cross-functionally to resolve complex provider contract issues.
Highly organized and able to successfully manage and prioritize multiple negotiations, issues, and other tasks to ensure completion and meet deadlines.

Nice To Haves

Experience with Commercial and Medicare lines of business.
Experience negotiating and managing contracts with large specialty provider groups.

Responsibilities

Recruits providers as needed to ensure network adequacy and achievement of network expansion goals.
Negotiates contracts with health care providers using pre-determined internal guidelines and financial standards.
Uses various sources of competitive intel to negotiate best in market discounts.
Develops rate proposals and performs financial analyses to ensure that results are within pre-determined targets.
Negotiates contract language in accordance with Aetna standards, engaging other departments as needed for review and approval of contract terms outside the standards.
Responsible for building contracts and amendments in contract management system in accordance with Aetna established guidelines, obtaining signatures, monitoring their progress post-signature, and verifying their accuracy post-release.
Manages contract performance and works with various internal departments to address questions, issues, and activities related to execution, loading, and ongoing maintenance of provider contracts.
Manages relationships with key providers and ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.
Negotiates settlements as needed.
Responsible for identifying and making recommendations to manage cost issues and supporting cost saving initiatives.