Manager, Contract Negotiations (Pacific Northwest)

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**

**Ideal candidate will sit in the WA, ID, or OR, however would be open to someone in the Pacific or Mountain time zones**

Position Summary

• Recruits providers as needed to ensure network adequacy and achievement of network expansion goals.

• Negotiates contracts with health care providers using pre-determined internal guidelines and financial standards.

• Uses various sources of competitive intel to negotiate best in market discounts. 

• Develops rate proposals and performs financial analyses to ensure that results are within pre-determined targets.

• Negotiates contract language in accordance with Aetna standards, engaging other departments as needed for review and approval of contract terms outside the standards.

• Responsible for building contracts and amendments in contract management system in accordance with Aetna established guidelines, obtaining signatures, monitoring their progress post-signature, and verifying their accuracy post-release.

• Manages contract performance and works with various internal departments to address questions, issues, and activities related to execution, loading, and ongoing maintenance of provider contracts.

• Supports the negotiation and implementation of value-based contract relationships in support of business strategies.

• Manages relationships with key providers and ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.

• Negotiates settlements as needed.

• Responsible for identifying and making recommendations to manage cost issues and supporting cost saving initiatives.

Required Qualifications

• A minimum of 5 years of experience negotiating contracts with ancillary providers, facilities, and physician groups, including contract language, development and analysis of rate proposals, identifying operational and financial improvement opportunities, and collection and analysis of competitive data and key financial metrics.  Uses competitive and financial data, as well as analysis detail, to negotiate favorable contracts.

• Understanding of common contract provisions, provider reimbursement methodologies and terms, and industry standard payment policies and practices.

• Understanding of provider financial issues, regulatory requirements, and competitor strategies.

• Demonstrates high proficiency with Microsoft Office suite applications (e.g., Outlook, Word, Excel, etc.)

• Ability to build collaborative relationships with providers and work cross-functionally to resolve complex provider contract issues.

• Highly organized and able to successfully manage and prioritize multiple negotiations, issues, and other tasks to ensure completion and meet deadlines.

Preferred Qualifications

• Experience with Commercial and Medicare lines of business.

• Experience negotiating and/or managing hospital contracts.

• Experience negotiating and/or managing value-based contracts brings added value.

Education

• Bachelor’s Degree or equivalent combination of education and professional work experience.

 

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$54,300.00 - $145,860.00

This 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

W