Provider Contract Negotiation Manager – Pacific Northwest
CVS Health
full-time
Posted on:
Location Type: Remote
Location: Alaska • Idaho • United States
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Salary
💰 $54,300 - $145,860 per year
About the role
- 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 goals, achieve regulatory and/or internal 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.
- Provides Subject Matter Expert support for questions related to recruitment initiatives, contracting, provider issues/resolutions, related systems and information contained.
- Provides guidance and share expertise to others on the team.
- 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.
- Optimizes interaction with assigned providers and internal business partners to manage relationships and ensure provider needs are met.
- Ensures resolution of escalated issues related to claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.
Requirements
- 3+ years related experience
- Proven and proficient negotiating skills
- Proven working knowledge of competitor strategies, complex contracting options, financial/contracting arrangements, and regulatory requirements
- Must reside in the Pacific Northwest market (Washington, Oregon, Alaska, or Idaho)
- In-depth knowledge of the managed care industry and practices
- Strong understanding of strategies, practices, and financial/contracting arrangements
- Must possess critical thinking, problem resolution and interpersonal skills
- Highly organized and self-driven
- Ability to forge meaningful, long-lasting relationships with providers
- Knowledge of Medicare programs and related subject matter
- Bachelor's degree preferred
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.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
contract negotiationcontract analysisdispute resolutionprovider recruitmentcost managementnetwork developmentstrategic network configurationclaims payment resolutionfinancial arrangementsregulatory compliance
Soft skills
negotiating skillscritical thinkingproblem resolutioninterpersonal skillsorganizational skillsself-drivenrelationship buildingcollaborationguidanceexpertise sharing