Senior Manager, Provider Contract Network Management

Position Summary

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.

This role negotiates, executes, conducts high-level review and analysis, dispute resolution and/or settlement negotiations of contracts with larger and more complex, market-based group/system providers in accordance with company standards in order to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals and cost initiatives.

Responsibilities

• Analyzes market needs and opportunities for network expansion, identifies gaps in the existing network, and proactively seeks new provider relationships to address those gaps.
• Ensures governance with healthcare regulations and contractual requirements, implementing strategies and processes to adhere to guidelines and requirements.
• Initiates moderate and/or complex contracting activities, including the collection of all required contract and credentialing documents, and obtains the necessary approval of non-standard rates and language modifications to contracts.
• Collaborates on negotiations or may handle contracting and re-contracting discussions with providers, provider groups and/or health systems.
• May participate in various internal and/or external meetings, serving as representative on behalf of the department.
• Supports or assists with operational activities that may include, but are not limited to, database management and contract coordination.
• Provides ongoing recommendations to leadership to guide decision-making and ensure alignment with the organization’s strategic goals.
• Coaches and mentors more junior level colleagues in contracting techniques, processes and responsibilities.

Required Qualifications

• 7+ years related experience and expert level negotiation skills with successful track record negotiating contracts with large or complex provider systems.
• Strong communication, critical thinking, problem resolution and interpersonal skills.
• Proven working knowledge of provider financial issues and competitor strategies, complex contracting options, financial/contracting arrangements and regulatory requirements.
• Medicaid Network Management experience.
• Reside within the Commonwealth of Virginia.

Education

• Bachelor’s Degree preferred or relevant professional experience.

Pay Range

The typical pay range for this role is: $75,400.00 - $165,954.00 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. This position also includes an award target in the company’s equity award program.

About CVS Health

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.

Benefits

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options
• A 401(k) plan (including matching company contributions)
• An employee stock purchase plan.