Manager, Network Relations

CVS Health

2d•$60,300 - $132,600•Onsite

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 This is an individual contributor role. Negotiates, executes, reviews, and analyzes contracts and/or handles dispute resolution and settlement negotiations with smaller providers (i.e., local individual providers and small groups/systems). Supports larger provider partners in accordance with company standards to maintain and enhance provider networks while meeting or exceeding accessibility, compliance, quality, and financial goals, as well as cost initiatives.

Requirements

5+ years of experience, based on education and professional background, negotiating contracts with ancillary providers, facilities, and physician groups.
Expertise includes contract language development, rate proposal analysis, and identification of operational and financial improvement opportunities.
Skilled in collecting and analyzing competitive data and key financial metrics to support negotiations and consistently secure favorable contract outcomes.
3+ years of experience in provider relationship management or related healthcare roles, with proven contract management skills.
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.
Demonstrated proficiency with Microsoft Office suite applications (e.g., Outlook, Word, Excel).
Ability to build collaborative relationships with providers and work cross-functionally to resolve complex contract issues.
Highly organized, with the ability to manage and prioritize multiple negotiations, issues, and tasks to meet deadlines.

Nice To Haves

Experience with both fee-for-service and value-based contracting is preferred.
Experience supporting the Medicaid line of business.
Knowledge of mental health reimbursement structures and clinical care delivery models.

Responsibilities

Negotiates, executes, reviews, and analyzes contracts and/or handles dispute resolution and settlement negotiations with solo, small group, or local providers.
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, submits contractual information, and supports the review and analysis of reports as part of negotiation and reimbursement modeling activities.
Identifies and recommends solutions to manage cost issues and supports cost-saving initiatives and/or settlement activities.
Provides network development, maintenance, and refinement strategies in support of the cross-market network management unit.
Assists with the design, development, management, and/or implementation of strategic network configurations, including integration activities.
Optimizes interactions with assigned providers and internal business partners to manage relationships and ensure provider needs are met.
Ensures resolution of escalated issues related to, but not limited to, claims payment, contract interpretation and parameters, and the accuracy of provider contract or demographic information.
Follows established procedures and protocols in completing standard contracts for providers.