Contract Negotiation Manager

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🐎 Kentucky – Remote

🐎 Kentucky – Remote

💵 $54.3k - $119.3k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

Healthcare Insurance • Retail • Wellness

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• 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.

🎯 Requirements

• 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

🏖️ Benefits

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