Negotiation Manager - PA, OH, WV, and Delaware

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 prioritize safety and quality in everything we do.

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. Works as an individual contributor to maintain and enhance provider networks while meeting accessibility, compliance, quality, and financial targets.

• 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.
• Both Fee for Service and Value based contracting experience preferred.
• 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.

• 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.
• 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.

• 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.

40

Full time

The typical pay range for this role is: $60,300.00 - $. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.