Payor Relations – Contracting Manager

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🏈 Ohio – Remote

🏈 Ohio – Remote

💵 $60.3k - $132.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

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

• Develop and maintain strategic relationships with physician partners across the Northern Ohio market • Lead contract management and provider relations initiatives supporting Commercial and Medicare lines of business • Develop, review, analyze, and execute provider contracts • Ensure proper implementation of negotiated agreements • Monitor contract performance against accessibility, compliance, quality, financial, and cost objectives • Lead innovative programs advancing contract negotiation initiatives across the organization • Anticipate industry changes, evaluate impacts, and formulate strategic responses • Design and implement provider recruitment systems supporting network expansion and adequacy goals • Conduct competitive analyses to inform reimbursement strategies • Collaborate cross-functionally on provider compensation methodologies and financial impacts of reimbursement models • Recommend strategies addressing cost challenges and drive cost-saving initiatives and settlement activities • Support network development, maintenance, and optimization • Mentor colleagues on best practices, processes, and responsibilities

🎯 Requirements

• 5 years of experience leading or supporting operational functions within healthcare administration or health insurance environments • 3+ years managing provider relationships and overseeing contract management functions • Ability to partner with internal and external stakeholders to identify root causes, develop solutions, and drive issue resolution within established timelines • Proficiency in Microsoft Word, Excel, and PowerPoint • 3+ years of provider contract negotiation or provider relations experience preferred • Experience with EPDB (Enterprise Provider Database), SCM (Strategic Contract Manager), and Provider Data Management preferred • Experience with Commercial and Medicare lines of business preferred • Exceptional written and verbal communication skills, particularly with external stakeholders preferred • Strong critical thinking, problem-solving, and interpersonal skills preferred • Candidates residing in Ohio are strongly preferred • Bachelor’s degree or equivalent combination of education and professional work experience

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program in addition to base pay • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being, based on eligibility