Senior Manager, Provider Contract Negotiation (California)

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 Senior Manager in an individual contributor position who negotiates, executes, conducts deep-dive review and analysis of dispute resolution and/or settlement negotiations of contracts with larger and more complex, market/regional/national based group/system providers including but not limited to Health Systems/Hospitals, large PCP groups, pediatricians, advanced specialist groups, hospital based providers, ancillary providers, ambulatory surgical centers, behavioral health providers, etc. in accordance with company standards. They will maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals and cost initiatives

Other Responsibilities Include but are not limited to:

• Recruit providers as needed to ensure attainment of network expansion goals, achieve regulatory and/or internal adequacy targets
• Support health plan with expansion initiatives or other contracting activities as needed
• Initiates, coordinates and own the contracting activities to fulfillment including receipt and processing of contracts and documentation and pre- and post-signature review of contracts and language modification according to Aetna’s established policies
• Responsible for auditing, building, and loading contracts, agreements, amendments and/or fee schedules in contract management systems per Aetna’s established policies
• Conducts research, analysis and/or audits to identify issues and propose solutions to protect data, contract integrity and performance
• Manages contract performance and supports the development and implementation of value-based contract relationships in support of business strategies
• Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities
• Provides Subject Matter Expert support for questions related to recruitment initiatives, contracting, provider issues/resolutions, related systems and information contained
• Provide guidance and share expertise to others on the team
• Understanding of Value Based contracting and negotiations
• Manage high level projects and recruitment initiatives with interdepartmental resources and/or cross functional stakeholders
• May participates in JOC meetings
• Supports or assists with operational activities that may include, but are not limited to, database management and contract coordination
• Organizing and transforming information into comprehensible structures
• Using data to predict trends in the customer base and the consumer population as a whole
• Performing statistical analysis of data
• Using tools and techniques to visualize data in easy-to-understand formats, such as diagrams and graphs
• Preparing reports and presenting these to leadership
• Engage with providers and quickly move the providers though contracting processes in order to ensure meeting network adequacy requirements
• This is an individual contributor role

Required Qualifications

• 7+ years of network contracting/management experience
• Ability to travel as needed (up to 10-25% travel)
• Candidate required to reside in California
• 5 years of solid negotiating and decision-making skills while executing national, regional, or market level strategies
• In-depth knowledge of the managed care industry and practices, as well as a strong understanding of strategies, practices, and financial/contracting arrangements
• Must possess critical thinking, problem resolution and interpersonal skills
• Highly organized and self-driven

Preferred Qualifications

• Ability to identify and capitalize on opportunities to support program delivery
• Communication Skills - Strong communication skills (written, verbal and presentation)
• Ability to forge meaningful, long-lasting relationships with providers
• Knowledge of Medicaid programs and related subject matter

Education

Bachelor’s degree desired or equivalent professional work experience

Pay Range

The typical pay range for this role is:

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.  This position also includes an award target in the company’s equity award program. 
 

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

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