Contract Manager

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 prioritize 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.

Position Summary

The Contract Manager 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.

Role/Responsibilities

• 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.
• 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.

Required Qualifications

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

3+ years of experience in provider relationship management or related healthcare roles, with proven and proficient contract management skills.

Strong communication, critical thinking, problem resolution and interpersonal skills.

Preferred Qualifications

Knowledge and/or experience in provider network contracting.

Proficiency in the Microsoft Office Suite.

Education

Bachelor's degree preferred or a combination of professional work experience and education.

Anticipated Weekly Hours: 40

Time Type: Full time

Pay Range: $60,300.00 - $132,600.00

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.