CVS Health-posted 4 months ago
$75,400 - $182,549/Yr
Full-time • Manager
Spokane, WA
5,001-10,000 employees
Ambulatory Health Care Services

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Strong preference for candidate to sit in Washington or Oregon. The Senior Manager negotiates, executes, conducts high level review and analysis, dispute resolution and/or settlement negotiations of contracts. Works with larger and more complex, market/regional/national based groups/systems in accordance with company standards to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals and cost initiatives. The Senior Manager will be responsible for contracting and implementing fee for service and value-based agreements with key physician groups, facilities, and ancillary providers to support commercial and individual exchange networks. This person will also work collaboratively with Aetna and CVS departments to identify initiatives to improve physician performance and quality of care provided to our members. 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.

  • Negotiate, execute, and conduct high level review and analysis of contracts.
  • Handle dispute resolution and settlement negotiations.
  • Work with larger and more complex market/regional/national based groups/systems.
  • Maintain and enhance provider networks while meeting accessibility, quality, and financial goals.
  • Contract and implement fee for service and value-based agreements with key physician groups, facilities, and ancillary providers.
  • Collaborate with Aetna and CVS departments to improve physician performance and quality of care.
  • Recruit providers to ensure network expansion and adequacy targets.
  • Manage provider compensation and pricing development activities.
  • Submit contractual information and review reports for negotiation and reimbursement modeling.
  • Minimum 5 years related experience in negotiating with individual or complex provider systems or groups.
  • Proven working knowledge of provider financial issues and competitor strategies.
  • Experience with large/complex contracting options and financial/contracting arrangements.
  • Understanding of regulatory requirements.
  • Strong communication, critical thinking, problem resolution, and interpersonal skills.
  • Experience with commercial, individual exchange, and Medicare.
  • Experience contracting with hospital systems and groups.
  • Advanced Excel experience including pivot tables and v-lookup function.
  • Affordable medical plan options.
  • 401(k) plan including matching company contributions.
  • Employee stock purchase plan.
  • No-cost wellness screenings, tobacco cessation, and weight management programs.
  • Confidential counseling and financial coaching.
  • Paid time off and flexible work schedules.
  • Family leave and dependent care resources.
  • Colleague assistance programs and tuition assistance.
  • Retiree medical access and many other benefits depending on eligibility.
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