Contract Negotiation Manager

This is a fully remote position, open to applicants in Connecticut, +6 more states.

📋 Description

• Negotiate, execute, review, and analyze contracts with individual, small-group, local, and various provider partners.

• Manage provider dispute resolution and conduct settlement negotiations.

• Oversee contract performance to support network quality, availability, financial goals, and strategic initiatives.

• Recruit providers to facilitate network expansion and meet adequacy targets.

• Collaborate across departments on provider compensation, pricing development, contractual details, reimbursement modeling, and report analysis.

• Identify and propose solutions for managing cost issues and support cost-saving initiatives and settlement activities.

• Offer strategies for network development, maintenance, and enhancement for cross-market network management.

• Assist in designing, developing, managing, and implementing strategic network configurations and integration efforts.

• Enhance interactions with designated providers and internal business partners to manage relationships and fulfill provider needs.

• Address escalated issues related to claims payment, contract interpretation and parameters, and the accuracy of provider contracts or demographic information.

⛳️ Requirements

• A minimum of 5 years of experience in negotiating contracts with ancillary providers, facilities, and physician groups.

• Experience in contract language, development and analysis of rate proposals, operational and financial improvement opportunities, competitive data, and key financial metrics.

• Over 3 years of experience in provider relationship management or related roles in healthcare.

• Strong contract management skills.

• Knowledge of common contract provisions, provider reimbursement methodologies and terms, and industry-standard payment policies and practices.

• Awareness of provider financial issues, regulatory requirements, and competitor strategies.

• High proficiency in Microsoft Office applications, including Outlook, Word, and Excel.

• Capability to build collaborative relationships with providers and work across functions to resolve complex provider contract issues.

• Ability to manage and prioritize multiple negotiations, issues, and tasks effectively to meet deadlines.

• Experience with Commercial and Medicare lines of business is preferred.

• Familiarity with Aetna systems and tools, such as Smart Front End, ASD, HRP, MedCompass, and RUMBA applications, or similar applications is preferred.

• Candidates residing in Pennsylvania, Ohio, Connecticut, Delaware, North Carolina, South Carolina, Florida, Georgia, and Texas are preferred.

• A bachelor's degree is preferred, or a combination of professional work experience and education.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program in addition to base salary.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being, based on eligibility.