Payor Relations – Contracting Manager

This is a fully remote position, open to applicants in Ohio.

📋 Description

• Build and sustain strategic partnerships with physician collaborators throughout the Northern Ohio region

• Oversee contract management and provider relations efforts that support both Commercial and Medicare business lines

• Develop, assess, analyze, and implement provider contracts

• Ensure proper execution of negotiated contracts

• Track contract performance in relation to accessibility, compliance, quality, financial, and cost objectives

• Spearhead innovative programs that enhance contract negotiation efforts across the organization

• Anticipate shifts in the industry, assess their impacts, and devise strategic responses

• Create and execute provider recruitment systems to support network expansion and adequacy goals

• Conduct competitive analyses to inform reimbursement strategies

• Work collaboratively across functions on provider compensation methodologies and the financial implications of reimbursement models

• Propose strategies to tackle cost challenges and promote cost-saving initiatives along with settlement activities

• Assist in the development, maintenance, and optimization of the network

• Mentor team members on best practices, processes, and responsibilities

⛳️ Requirements

• A minimum of 5 years of experience leading or supporting operational functions within healthcare administration or health insurance settings

• At least 3 years of experience managing provider relationships and overseeing contract management tasks

• Ability to collaborate with internal and external stakeholders to identify root causes, develop solutions, and facilitate issue resolution within set timelines

• Proficient in Microsoft Word, Excel, and PowerPoint

• Preferred: 3+ years of experience in provider contract negotiation or provider relations

• Preferred: Familiarity with EPDB (Enterprise Provider Database), SCM (Strategic Contract Manager), and Provider Data Management

• Preferred: Experience with Commercial and Medicare business lines

• Preferred: Outstanding written and verbal communication skills, especially with external stakeholders

• Preferred: Strong critical thinking, problem-solving, and interpersonal abilities

• Candidates residing in Ohio are highly preferred

• Bachelor's degree or a combination of education and relevant professional experience equivalent

🏝️ Benefits

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

• Comprehensive medical coverage

• Dental insurance

• Vision insurance

• Paid time off

• Retirement savings options

• Wellness programs

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