CVS Health

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Provider Contract Negotiator

at CVS Health

Posted: 9/10/2020
Job Status: Contract/Temporary
Job Reference #: 72525BR
Categories: Sales
Keywords:

Job Description

Job Description
Negotiates, executes, reviews, and analyzes contracts and/or handles dispute resolution and settlement negotiations with smaller providers ( (i.e. local, individual providers, small groups/systems) in accordance with company standards in order to maintain and enhance provider networks while meeting and exceeding accessibility, compliance, quality, and financial goals and cost initiatives.

Fundamental Components
  • Negotiates, executes, reviews, and analyzes contracts and/or handles dispute resolution and settlement negotiations with solo, small group, or local providers.
  • Manages contract performance in support of network quality, availability, and financial goals and strategies.
  • Recruits providers as needed to ensure attainment of network expansion and adequacy targets.
  • Collaborates cross-functionally to contribute to provider compensation and pricing development activities and recommendations, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities.
  • Responsible for identifying and making recommendations to manage cost issues and supporting cost saving initiatives and/or settlement activities.
  • Provides 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.
  • May optimize interaction with assigned providers and internal business partners to manage 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.


Background Experience
  • 3-5 years of Managed Care or Health plan experience required
  • 3-5 years related experience, proven and proficient negotiating skills.
  • Proven working knowledge of competitor strategies, complex contracting options, value based contracting, financial/contracting arrangements and regulatory requirements.
  • Strong communication, critical thinking, problem resolution and interpersonal skills.
  • Bachelor’s Degree or equivalent combination of education and experience.


Additional Job Information
Prior Health Plan or managed care experience.

Education
Bachelor's degree or equivalent experience

Percent of Travel Required
0 - 10%

Business Overview
Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!