Senior Provider Network Contracting (IL/MO)

CVS Health•Carapichaima, IL

13d

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 Negotiates, executes, and analyzes contracts with larger and more complex healthcare group/system providers, focusing on maintaining and enhancing the provider network while meeting accessibility, quality, and financial goals. Handles dispute resolution and settlement negotiations, ensuring compliance with company standards and regulatory requirements. Leverages extensive negotiation skills and working knowledge of provider financial issues to optimize contracts, and collaborates with large hospitals and health systems to achieve successful contracting outcomes, all while supporting cost-saving initiatives and the growth of the provider network. Negotiates, executes, and conducts high-level review and analysis of contracts with larger and more complex group/system providers while ensuring contracts align with company standards and goals related to accessibility, quality, and financial performance. Manages and facilitates dispute resolution processes to address issues arising from provider contracts, ensuring equitable solutions. Leads contract settlement negotiations, striving to reach mutually beneficial agreements with providers that maintain and enhance the provider network. Implements strategies to enhance and expand the provider network, while ensuring it meets accessibility and quality standards. Aligns provider contracts with financial goals and cost-saving initiatives, ensuring that contracts support the company's financial objectives. Conducts comprehensive reviews and analyses of provider contracts, identifying areas for improvement and optimization. Ensures that all provider contracts adhere to regulatory requirements, maintaining compliance with healthcare regulations. Utilizes working knowledge of provider financial issues and competitor strategies to inform negotiation and contracting decisions. Facilitates leadership, guidance, and mentorship to a team of professionals by setting strategic objectives, monitoring team performance, providing training and development opportunities, and fostering a collaborative and innovative work environment.

Requirements

A minimum 7 years of experience contracting with providers within the healthcare industry.
A minimum 5 years of direct hospital contracting experience.
Experience with Commercial, Medicare, and Medicaid lines of business.
Adept at problem solving and decision making skills, based on data and trends.
Adept at collaboration and teamwork.
Growth mindset (agility and developing yourself and others) skills.
Execution and delivery (planning, delivering, and supporting) skills.
Business intelligence and communication skills across multiple levels of leadership.
Ability to travel within assigned territory if needed.

Nice To Haves

Strong understanding of the IL and MO market, including local payer and provider dynamics.
Hands-on experience with value-based contracting and alternative payment arrangements.

Responsibilities

Negotiates, executes, and analyzes contracts with larger and more complex healthcare group/system providers.
Maintains and enhances the provider network while meeting accessibility, quality, and financial goals.
Handles dispute resolution and settlement negotiations.
Ensures compliance with company standards and regulatory requirements.
Optimizes contracts using extensive negotiation skills and working knowledge of provider financial issues.
Collaborates with large hospitals and health systems to achieve successful contracting outcomes.
Supports cost-saving initiatives and the growth of the provider network.
Conducts high-level review and analysis of contracts with larger and more complex group/system providers.
Ensures contracts align with company standards and goals related to accessibility, quality, and financial performance.
Manages and facilitates dispute resolution processes to address issues arising from provider contracts.
Leads contract settlement negotiations.
Implements strategies to enhance and expand the provider network.
Aligns provider contracts with financial goals and cost-saving initiatives.
Conducts comprehensive reviews and analyses of provider contracts, identifying areas for improvement and optimization.
Ensures that all provider contracts adhere to regulatory requirements.
Utilizes working knowledge of provider financial issues and competitor strategies to inform negotiation and contracting decisions.
Facilitates leadership, guidance, and mentorship to a team of professionals by setting strategic objectives, monitoring team performance, providing training and development opportunities, and fostering a collaborative and innovative work environment.