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CVS Health · 1 month ago

Contract Negotiator Manager - Providers

Denver, CO

Full-time, Contract

Hybrid

Mid Level

$54K/yr - $146K/yr

3+ years exp

CVS Health is the nation’s leading health solutions company, dedicated to transforming health care. The Contract Negotiator Manager - Providers will be responsible for recruiting providers, negotiating contracts, managing contract performance, and supporting value-based contract relationships to achieve network expansion goals.

Health CareMedicalPharmaceuticalRetailSales

Responsibilities

Recruits providers as needed to ensure network adequacy and achievement of network expansion goals

Negotiates contracts with health care providers using pre-determined internal guidelines and financial standards

Uses various sources of competitive intel to negotiate best in market discounts

Develops rate proposals and performs financial analyses to ensure that results are within pre-determined targets

Negotiates contract language in accordance with Aetna standards, engaging other departments as needed for review and approval of contract terms outside the standards

Responsible for building contracts and amendments in contract management system in accordance with Aetna established guidelines, obtaining signatures, monitoring their progress post-signature, and verifying their accuracy post-release

Manages contract performance and works with various internal departments to address questions, issues, and activities related to execution, loading, and ongoing maintenance of provider contracts

Supports the negotiation and implementation of value-based contract relationships in support of business strategies

Manages relationships with key providers and ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information

Negotiates settlements as needed

Responsible for identifying and making recommendations to manage cost issues and supporting cost saving initiatives

Qualification

Contract negotiationFinancial analysisProvider reimbursement methodologiesMicrosoft Office proficiencyAnalytical skillsProblem resolutionRelationship managementCommunication skillsNegotiation skillsDecision-making skillsOrganizational skills

Required

3+ years of experience negotiating contracts with ancillary providers, facilities, physician groups, and IPAs, including contract language, development and analysis of rate proposals, identifying operational and financial improvement opportunities, and collection and analysis of competitive data and key financial metrics. Uses competitive and financial data, as well as analysis detail, to negotiate favorable contracts

Understanding of common contract provisions, provider reimbursement methodologies and terms, and industry standard payment policies and practices

Understanding of provider financial issues, regulatory requirements, and competitor strategies

Demonstrates high proficiency with Microsoft Office suite applications (e.g., Outlook, Word, Excel, etc.)

Detail-oriented with strong communication, analytical and negotiation skills

Able to manage expectations and maintain strong relationships, both internally and externally

Ability to build collaborative relationships with providers and work cross-functionally to resolve complex provider contract issues

Highly organized and able to successfully manage and prioritize multiple negotiations, issues, and other tasks to ensure completion and meet deadlines

Preferred

Strong problem resolution and decision-making skills

Experience negotiating and/or managing hospital contracts

Experience negotiating and/or managing value-based contracts brings added value

Benefits

Affordable medical plan options

401(k) plan (including matching company contributions)

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