Contract Negotiation Manager - PA, OH, WV, and Delaware

This is an individual contributor role. Negotiates, executes, reviews, and analyzes contracts and/or handles dispute resolution and settlement negotiations with smaller providers (i.e. local, individual providers, small groups/systems), services larger provider partners in accordance with company standards in order to maintain and enhance provider networks while meeting and exceeding accessibility, compliance, quality, and financial goals and cost initiatives.

Responsibilities

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 and 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.; 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.

Requirements

A minimum of 5 years of experience negotiating contracts with ancillary providers, facilities, and physician groups, 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.; 3+ years of experience in provider relationship management or related healthcare roles, with proven and proficient contract management skills.; 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.); 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.

Nice to have

Both Fee for Service and Value based contracting experience preferred; Experience with Commercial and Medicare lines of business; Candidates located in Pennsylvania, Ohio, West Virginia, and Delaware are strongly preferred; Bachelor's degree preferred or a combination of professional work experience and education.

Benefits

CVS Health bonus, commission or short-term incentive program; medical, dental, and vision coverage; paid time off; retirement savings options; wellness programs; other resources