Provider Contract Negotiation Manager
Sign up free to see how well your resume matches this role.
What you'll do
- Negotiate single case agreements for episodes of care on a pre-service basis.
- Participation/engagement of looking at forecast changes within the Contract Negotiations industry, development of business impact assessments, and modification strategies with the aid of process improvement methodologies.
- Determines recommendations to manage cost issues and support cost-saving initiatives and settlement activities.
- Develop, maintain, and enhance working relationships with physicians/providers and local network and patient management teams in the markets within Aetna.
- Coaches more junior colleagues in techniques, processes, and responsibilities.
- Collaborates cross-functionally with internal teams to support and manage negotiations, ensuring alignment and successful outcomes.
What they're looking for
- 5+ years of experience in provider contracting, claims management, or patient management.
- 2+ years of experience in claims operations or a related claims management environment.
- 1-2 years of experience working with ACAS and HRP claims platforms, products, and benefits, as well as patient management, provider relations, or claims management.
Nice to have
- Knowledge/experience with National Advantage Program within Aetna.
- Working knowledge of Aetna systems and tools, including Smart Front End, ASD, HRP, MedCompass, and RUMBA applications (EPDB, EWMP, Rate Inquiry, and Contract Inquiry).
- Bachelor's degree preferred or a combination of professional work experience and education.
Summarised by NextRaise from the employer’s description, which follows in full below.
Full description from employer
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.
Position Summary
This is an individual contributor role.
This remote position constructs negotiation, execution, review, and analysis of contracts. Delivers dispute resolution and settlement negotiations with providers. Ensures contract performance aligns with accessibility, compliance, quality, financial, and cost goals.
What you will do
- Negotiate single case agreements for episodes of care on a pre-service basis.
- Participation/engagement of looking at forecast changes within the Contract Negotiations industry, development of business impact assessments, and modification strategies with the aid of process improvement methodologies.
- Determines recommendations to manage cost issues and support cost-saving initiatives and settlement activities.
- Develop, maintain, and enhance working relationships with physicians/providers and local network and patient management teams in the markets within Aetna.
- Coaches more junior colleagues in techniques, processes, and responsibilities.
- Collaborates cross-functionally with internal teams to support and manage negotiations, ensuring alignment and successful outcomes.
Required Qualifications
- 5+ years of experience in provider contracting, claims management, or patient management.
- 2+ years of experience in claims operations or a related claims management environment.
- 1-2 years of experience working with ACAS and HRP claims platforms, products, and benefits, as well as patient management, provider relations, or claims management.
Preferred Qualifications
- Knowledge/experience with National Advantage Program within Aetna.
- Working knowledge of Aetna systems and tools, including Smart Front End, ASD, HRP, MedCompass, and RUMBA applications (EPDB, EWMP, Rate Inquiry, and Contract Inquiry).
Education
- Bachelor's degree preferred or a combination of professional work experience and education.
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$60,300.00 - $132,600.00This 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.
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.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Company
Company facts come from this company's own listings. We only show what the postings themselves carry.