Description

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

The Contract Negotiation Manager will negotiate and execute high-level review and analysis, manage dispute resolution and settlement negotiations of contracts with single and group Behavioral Health providers within a defined market. You will manage contract performance and support the development and implementation of strategic, traditional contracts and value-based contract relationships.

• Negotiates, executes, reviews, and analyzes contracts and/or handles dispute resolution and settlement negotiations with solo and group Behavioral Health providers for all lines of business (Medicare, commercial etc.).
• Manages contract performance in support of network quality, availability, and financial goals and strategies for all lines of business (Medicare, commercial etc.).
• Recruits Behavioral Health providers as needed to ensure attainment of network expansion and adequacy targets for all lines of business (Medicare, commercial etc.).
• 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 Behavioral Health network development, maintenance, and refinement activities and strategies in support of cross-market network management unit.
• Assists with the design, development, management, and or implementation of strategic network configurations, including integration activities. May optimize interaction with assigned providers and internal business partners to manage relationships and ensure provider needs are met. Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.

Required Qualifications

• Minimum 3+ years related experience, proven and proficient managed care network negotiating skills.
• Proven working knowledge of competitor strategies, complex contracting options, financial/contracting arrangements, and regulatory requirements.
• Strong and persuasive communication skills, especially written communications, with external stakeholders
• Strong critical thinking, problem resolution and interpersonal skills
• Adept at execution and delivery (planning, delivering, and supporting) skills
• A ready business acumen and the ability to balance and articulate competing priorities while making decisions
• Adept at collaboration and teamwork

Preferred Qualifications

• Versed with the Georgia Behavioral Health provider market highly preferred. Priority will be for those located in Georgia. Candidates in AL, AR, FL, LA, MS, NC, SC and TN will also be considered.
• 3-5 years related experience Commercial HMO, PPO products knowledge
• 3-5 years related experience Medicare and/or Medicaid products knowledge

Education

• Bachelor's degree preferred/specialized training/relevant professional qualification.

Anticipated Weekly Hours
40

Time Type
Full time

Pay Range

The typical pay range for this role is:

$54,300.00 - $119,340.00

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

We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 04/30/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.