Manager, Provider Contract Negotiation (Georgia)

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.

• Entry level contracting role for a candidate with minimal contracting experience and background.
• Project management skills to prioritize competing priorities and effectively communicate provider contracting scenarios with attention to detail based on a thorough evaluation of provider data using internal tools.

• Manages contract performance and drives the development and implementation of value-based contract relationships in support of business strategies.
• 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.
• Responsible for identifying and managing cost issues and collaborating cross functionally to execute significant cost saving initiatives.
• Represents company with high visibility constituents, including customers and community groups. Promotes collaboration with internal partners.
• Evaluates, helps formulate, and implements the provider network strategic plans to achieve contracting targets and manage medical costs through effective provider contracting to meet state contract and product requirements. Collaborates with internal partners to assess effectiveness of tactical plan in managing costs.
• May optimize interaction with assigned providers and internal business partners to facilitate 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.

• 5+ years experience in a provider relations, contracting or managed care environment

• Knowledge of the managed care industry and practices, as well as a strong understanding of strategies, practices, and financial/contracting arrangements.

• Must possess critical thinking, problem resolution, organizational and interpersonal skills.

• Highly organized and self-driven

• • Ability to forge meaningful, long-lasting relationships with providers.

  • Physician, Ancillary and/or Commercial experience

  • Knowledge of Medicare programs and related subject matter

• Bachelor’s degree and relevant training or work experience

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.