Senior Manager, Contract Negotiation Manager (Ohio)

CVS Health

7d

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. Requisition Job Description Position Summary This position supports Ancillary Provider Contracting and Relationship Management for the Commercial and Medicare Segments. Negotiates, executes, reviews, and analyzes contracts and/or handles dispute resolution and settlement negotiations with ancillary providers in accordance with company standards to maintain and enhance provider networks while meeting and exceeding accessibility, compliance, quality, and financial goals and cost incentives Manages contract performance in support of network quality, availability, and financial goals and strategies Recruit providers as needed to ensure attainment of network expansion and adequacy targets Collaborates cross -functionally to contribute to provider compensation and pricing development activities, recommendations, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities Integrates cross-functional collaboration to contribute to provider compensation and pricing development activities and recommendations for negotiations and reimbursement modeling activities. Identifying and making recommendations to manage cost issues and supporting cost saving initiatives and/or settlement activities Provides ancillary network development, maintenance, and refinement activities and strategies in support of cross-market network management unit Assists with the design, development, management, and/or implementation of strategic network configurations, including integration activities Optimizes interaction with assigned providers and internal business partners to manage relationships and ensure providers 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 Coaches more junior colleagues in techniques, processes, and responsibilities.

Requirements

• 5+ years of Provider Contract Network and Negotiation experience preferably within the ancillary space.
• Proven working knowledge of competitor strategies, complex contracting options, financial/contracting arrangements, and regulatory requirements
• 3+ years related experience Commercial HMO, PPO products knowledge
• 3+ years related experience Medicare and/or Medicaid products knowledge
• Must reside in Ohio

Nice To Haves

• Intermediate knowledge of Microsoft Office, specifically Excel and PowerPoint
• A ready business acumen and the ability to balance and articulate competing priorities while making decisions
• Strong and persuasive communication skills, especially written communications, with external stakeholders
• Strong critical thinking, problem resolution and interpersonal skills
• Adept at execution and delivery (planning, delivering, and supporting) skills
• Adept at collaboration and teamwork
• A growth mindset (agility and developing yourself and others) skills

Responsibilities

• Negotiates, executes, reviews, and analyzes contracts and/or handles dispute resolution and settlement negotiations with ancillary providers in accordance with company standards to maintain and enhance provider networks while meeting and exceeding accessibility, compliance, quality, and financial goals and cost incentives
• Manages contract performance in support of network quality, availability, and financial goals and strategies
• Recruit providers as needed to ensure attainment of network expansion and adequacy targets
• Collaborates cross -functionally to contribute to provider compensation and pricing development activities, recommendations, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities
• Integrates cross-functional collaboration to contribute to provider compensation and pricing development activities and recommendations for negotiations and reimbursement modeling activities.
• Identifying and making recommendations to manage cost issues and supporting cost saving initiatives and/or settlement activities
• Provides ancillary network development, maintenance, and refinement activities and strategies in support of cross-market network management unit
• Assists with the design, development, management, and/or implementation of strategic network configurations, including integration activities
• Optimizes interaction with assigned providers and internal business partners to manage relationships and ensure providers 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
• Coaches more junior colleagues in techniques, processes, and responsibilities.

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior