Provider Network Contracting Manager
| Company | CVS Health |
|---|---|
| Location | Trenton, NJ, USA, Hartford, CT, USA, New York, NY, USA |
| Salary | $66330 – $159120 |
| Type | Full-Time |
| Degrees | |
| Experience Level | Mid Level, Senior |
Requirements
- Minimum 3+ years related experience, proven and proficient managed care network negotiating skills.
- Proven working knowledge of competitor strategies, contracting options, financial/contracting arrangements, and regulatory requirements.
- Strong and persuasive communication skills, especially written communications, with external stakeholders
- Strong critical thinking, problem resolution and interpersonal skills
- Adept at execution and delivery (planning, delivering, and supporting) skills.
- A ready business acumen and the ability to balance and articulate competing priorities while making decisions.
- Adept at collaboration and teamwork within a highly matrix environment.
Responsibilities
- Negotiates, executes, reviews, and analyzes contracts and/or handles dispute resolution and settlement negotiations with solo and group providers for all lines of business (Medicare, commercial etc.).
- Manages contract performance in support of network quality, availability, and financial goals and strategies for all lines of business (Medicare, commercial etc.).
- Recruits providers as needed to ensure attainment of network expansion and adequacy targets for all lines of business (Medicare, commercial etc.).
- 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.
- 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. May optimize interaction with assigned providers and internal business partners to manage 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.
Preferred Qualifications
- Bachelor’s degree preferred/specialized training/relevant professional qualification