Provider Contract Negotiation Manager

CVS Health•Indianapolis, NV

1d•$60,300 - $132,600•Remote

About The Position

This is an individual contributor role. This remote position constructs negotiation, execution, review, and analysis of contracts. Delivers dispute resolution and settlement negotiations with providers. Ensures contract performance aligns with accessibility, compliance, quality, financial, and cost goals.

Requirements

5+ years of experience in provider contracting, claims management, or patient management.
2+ years of experience in claims operations or a related claims management environment.
1-2 years of experience working with ACAS and HRP claims platforms, products, and benefits, as well as patient management, provider relations, or claims management.

Nice To Haves

Knowledge/experience with National Advantage Program within Aetna.
Working knowledge of Aetna systems and tools, including Smart Front End, ASD, HRP, MedCompass, and RUMBA applications (EPDB, EWMP, Rate Inquiry, and Contract Inquiry).

Responsibilities

Negotiate single case agreements for episodes of care on a pre-service basis.
Participation/engagement of looking at forecast changes within the Contract Negotiations industry, development of business impact assessments, and modification strategies with the aid of process improvement methodologies.
Determines recommendations to manage cost issues and support cost-saving initiatives and settlement activities.
Develop, maintain, and enhance working relationships with physicians/providers and local network and patient management teams in the markets within Aetna.
Coaches more junior colleagues in techniques, processes, and responsibilities.
Collaborates cross-functionally with internal teams to support and manage negotiations, ensuring alignment and successful outcomes.