Project Manager, Provider Network Contract Validation at CVS Health

Hartford, Connecticut, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Experience with SCM (Strategic Contract Manager) and/or EPDB (Enterprise Provider Database), and/or HRP (Health Rules Payor)
Basic understanding of Provider Contracting
Project Management experience
Experience with EXCEL and working with large data files
Bachelor's degree preferred/specialized training/relevant professional qualification

Responsibilities

Reviewing, auditing, and coordinating the correction (if necessary) of HRP contract setup against contract intent
Evaluating the pricing performance of claims
Ensuring accurate provider pricing configuration in HRP prior to contract implementation
Working closely with areas such as Network, Provider Data Services, Next Gen Provider Contract/Pricing team, Business Intent Review (BIR), HRP Provider Demographics, HRP Claims, HRP Product, legal/compliance, medical policy, and/or segment leaders to ensure correct decisions in configuring contract and pricing features
Participating in workgroups for process improvement

Skills

Key technologies and capabilities for this role

Project ManagementSCMEPDBHRPProvider ContractingExcelClaims ProcessingContract ValidationAuditingData Analysis

Questions & Answers

Common questions about this position

What is the pay range for this Project Manager role?

The typical pay range for this role is $54,300.00 - $159,120.00, representing the base annual full-time salary. The actual base salary offer will depend on a variety of factors.

Is this a remote or on-site position?

This information is not specified in the job description.

What are the required qualifications for this role?

Required qualifications include experience with SCM (Strategic Contract Manager) and/or EPDB (Enterprise Provider Database), and/or HRP (Health Rules Payor), basic understanding of Provider Contracting, Project Management experience, and experience with EXCEL and working with large data files.

What is the company culture like at CVS Health?

CVS Health emphasizes building a world of health around every consumer with dedicated, purpose-driven colleagues passionate about transforming health care in a connected, convenient, and compassionate way.

What makes a strong candidate for this position?

Strong candidates will have the required experience with SCM, EPDB, or HRP, provider contracting knowledge, and Excel proficiency, plus preferred skills like claims processing experience, proven project milestone achievement, strong communication, and organization skills.

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters

1963Year Founded

DEBTCompany Stage

Healthcare, Consumer GoodsIndustries

10,001+Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.

The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.

The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.

The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.

CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.

Increased consumer interest in wellness boosts demand for CVS's health-related products.

The trend towards value-based care aligns with CVS's integrated healthcare approach.

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