Contract Negotiation Manager

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🕒 Junho 11

🐎 Kentucky – Remoto

🐎 Kentucky – Remote

💵 $54.300 - $119.340 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

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CVS Health

SiteLinkedInTodas as Vagas

10.000+ funcionários

Fundada em 1963

⚕️ Seguro de Saúde

🛒 Varejo

🧘 Bem-estar

Healthcare Insurance • Retail • Wellness

CVS Health é uma empresa líder de saúde nos Estados Unidos, dedicada a ampliar o acesso e a acessibilidade ao cuidado. A empresa adota uma abordagem abrangente que inclui serviços de saúde, seguro saúde e gestão de benefícios farmacêuticos (PBM). Por meio de suas subsidiárias, como Aetna e CVS Caremark, a CVS Health oferece uma variedade de serviços que promovem o bem-estar, a gestão de condições de saúde e a cobertura acessível de medicamentos prescritos. A CVS Health opera farmácias de bairro, oferece serviços de farmácia por correspondência e gerencia programas de medicamentos de especialidade, com o objetivo de tornar o cuidado com a saúde conveniente e acessível para todos. Movida pela missão de conectar pessoas a serviços essenciais de cuidado, a CVS Health está comprometida em fomentar comunidades mais saudáveis e apoiar o bem-estar de todas as pessoas.

Descrição

• Reviews, analyzes, negotiates and executes Medicaid contracts. • Leads reimbursement dispute resolution and settlement negotiations with provider groups for the Medicaid line of business. • Completes all activities related to standard contract intake and implementation. • 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 as applicable. • Provides contract expertise and support to other internal business partners/units related to contract setup accuracy, language interpretation, claims payment and/or other matters requiring network contracting expertise. • Leads and/or participates in special projects.

🎯 Requisitos

• 3-5 years experience with provider contract negotiations or provider relations experience • Proven working knowledge of the Medicaid service line, preferably the state of Kentucky program. • Must reside in the state of Kentucky • Medicaid provider relations or claims payment expertise (preferred) • Proven and proficient managed care network negotiating skills. • Strong communication, critical thinking, problem resolution and interpersonal skills • Adept at execution and delivery (planning, delivering, and supporting) skills • Adept at business intelligence • Adept at collaboration and teamwork • Adept at growth mindset (agility and developing yourself and others) skills

🏖️ Benefícios

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • other resources, based on eligibility