Manager, Provider Contract Negotiation (Georgia)

CVS Health•Conyers, GA

5d•Hybrid

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. This is an entry-level contracting role for a candidate with minimal contracting experience and background. The role requires project management skills to prioritize competing priorities and effectively communicate provider contracting scenarios with attention to detail based on a thorough evaluation of provider data using internal tools. The Manager will manage contract performance and drive the development and implementation of value-based contract relationships in support of business strategies. They will recruit providers as needed to ensure attainment of network expansion and adequacy targets and be accountable for cost arrangements within defined groups. This role collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities. The Manager is responsible for identifying and managing cost issues and collaborating cross-functionally to execute significant cost-saving initiatives. They will represent the company with high visibility constituents, including customers and community groups, and promote collaboration with internal partners. The role involves evaluating, formulating, and implementing provider network strategic plans to achieve contracting targets and manage medical costs through effective provider contracting to meet state contract and product requirements. Collaboration with internal partners to assess the effectiveness of tactical plans in managing costs is also a key aspect. The role may optimize interaction with assigned providers and internal business partners to facilitate relationships and ensure provider needs are met. Ensuring the resolution of escalated issues related to claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information is also a responsibility.

Requirements

5+ years experience in a provider relations, contracting or managed care environment
Knowledge of the managed care industry and practices, as well as a strong understanding of strategies, practices, and financial/contracting arrangements.
Must possess critical thinking, problem resolution, organizational and interpersonal skills.
Highly organized and self-driven
Must reside in Georgia and able to drive into the Atlanta office location 1x per month

Nice To Haves

Ability to forge meaningful, long-lasting relationships with providers.
Physician, Ancillary and/or Commercial experience
Knowledge of Medicare programs and related subject matter

Responsibilities

Manages contract performance and drives the development and implementation of value-based contract relationships in support of business strategies.
Recruits providers as needed to ensure attainment of network expansion and adequacy targets.
Accountable for cost arrangements within defined groups.
Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities.
Responsible for identifying and managing cost issues and collaborating cross functionally to execute significant cost saving initiatives.
Represents company with high visibility constituents, including customers and community groups.
Promotes collaboration with internal partners.
Evaluates, helps formulate, and implements the provider network strategic plans to achieve contracting targets and manage medical costs through effective provider contracting to meet state contract and product requirements.
Collaborates with internal partners to assess effectiveness of tactical plan in managing costs.
May optimize interaction with assigned providers and internal business partners to facilitate relationships and ensure provider needs are met.
Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.