Senior Contract Manager

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritise safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

This is an individual contributor role.

The Senior Contract Manager for First Health Network Management serves as the subject matter expert in support of contracting initiatives and data audits to enhance provider networks while meeting and exceeding accessibility, compliance, quality, and financial goals. Responsible for reviewing, building and auditing complex contract and network data, support recruitment efforts, and collaborating on negotiations as needed.

Negotiates, executes, reviews, and analyzes contracts and/or handles dispute resolution and settlement negotiations with solo, small group, or local providers, including SCAs, LOAs, and PPAs. Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities. Responsible for identifying and managing cost issues and collaborating cross functionally to execute significant cost saving initiatives.

Represents company with high visibility constituents, including customers and community groups. Promotes collaboration with internal partners. Manages contract performance in support of network quality, availability, and financial goals and strategies. Recruits providers 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. Interprets contractual requirements including federal and state regulations and NCQA.

7+ years of progressive experience leading complex initiatives and delivering measurable business outcomes.

5+ years of working knowledge in the healthcare industry, including competitor strategies, complex contracting options, financial and contracting arrangements, and regulatory requirements.

Demonstrated ability to manage multiple priorities simultaneously while executing against timelines, budgets, and performance objectives.

Proven track record of identifying issues, analyzing data, and making sound decisions to drive operational and financial results.

Experience influencing and partnering with cross-functional stakeholders to achieve shared business goals and enterprise-wide outcomes.

Demonstrated ability to influence across a highly matrixed organization and partner…