Manager, Contract Negotiator - Metro NY

CVS Health•Staten Island, NY

18h•Hybrid

About The Position

Aetna is seeking a Manager, Contract Negotiator to support the Metro New York market. This role is responsible for developing, negotiating, implementing, and maintaining provider contracts with physicians, hospitals, ancillary providers, and health systems in support of Aetna's network strategy, affordability goals, provider access requirements, and member experience objectives. The Manager, Contract Negotiator will lead contract negotiations for assigned providers, analyze financial and operational impacts of proposed agreements, and collaborate with cross-functional partners to drive network performance. This role serves as a key liaison between providers and internal business partners including Network Strategy, Provider Relations, Finance, Actuarial, Legal, Clinical, Operations, and Compliance. The ideal candidate possesses strong negotiation capabilities, healthcare industry knowledge, financial acumen, and the ability to build productive relationships with provider organizations in one of Aetna's largest and most complex provider markets.

Requirements

A minimum of 3 years of healthcare provider contracting, network management, provider relations, reimbursement, health plan operations, healthcare consulting, or related experience.
Strong analytical skills with experience evaluating financial models, reimbursement structures, utilization patterns, and provider performance data.
Working knowledge of healthcare reimbursement methodologies including fee-for-service, value-based care, capitation, and risk-based arrangements.
Experience partnering across a highly matrixed organization and influencing stakeholders without direct authority.
Strong problem-solving, decision-making, and negotiation skills.
Excellent verbal, written, and presentation communication skills.
Ability to manage multiple priorities simultaneously and deliver results in a fast-paced environment.
Proficient in Microsoft Excel, PowerPoint, and other analytical tools.
Bachelor's degree or equivalent combination of education and relevant professional experience.

Nice To Haves

Experience negotiating contracts with hospitals, integrated delivery systems, academic medical centers, or large physician organizations.
Demonstrated experience negotiating provider contracts, reimbursement methodologies, or healthcare service agreements.
Experience supporting provider contracting activities within the Metro New York healthcare market.
Knowledge of Commercial, Medicare, Medicaid, and ACA products.
Experience with value-based care programs, alternative payment models, and risk-based contracting arrangements.
Knowledge of provider network adequacy standards, healthcare regulatory requirements, and contracting compliance practices.
Experience with healthcare claims analysis, reimbursement modeling, or provider performance reporting.
Familiarity with Aetna network management systems, provider contracting platforms, or contract administration tools.
Proven ability to influence senior provider executives and lead complex negotiations involving multiple stakeholders.
Experience supporting network strategy, affordability initiatives, and provider performance improvement efforts.

Responsibilities

Negotiate, execute, renew, and maintain provider agreements with hospitals, physician groups, ancillary providers, and other healthcare organizations.
Develop and implement contracting strategies that support market affordability, network adequacy, access, quality, and growth objectives.
Analyze provider reimbursement proposals, financial models, utilization trends, and contract performance data to support negotiations and business decision-making.
Manage contract amendments, reimbursement updates, fee schedule changes, and contract renewals.
Establish and maintain strong relationships with provider executives and key decision makers.
Collaborate with Provider Relations, Network Strategy, Finance, Actuarial, Legal, Compliance, Clinical, and Operations teams to support implementation and administration of provider agreements.
Identify opportunities for cost savings, network optimization, and provider performance improvement.
Support value-based care arrangements and alternative payment models, including performance-based reimbursement structures.
Resolve provider disputes and contract-related issues while maintaining positive provider relationships.
Ensure compliance with regulatory requirements, corporate policies, and contracting standards.
Support provider recruitment, network expansion, and network adequacy initiatives.
Prepare negotiation strategies, executive summaries, business cases, and leadership presentations.
Coach and mentor less experienced network contracting colleagues and support cross-functional project initiatives as needed.