Contract Negotiation Manager

About the Role

This is an individual contributor role. The Contract Manager serves as the subject matter expert in support of contracting initiatives and data audits to enhance provider networks while meeting and exceeding accessibility, compliance, quality, and financial goals. Responsible for reviewing, building, and auditing complex contract and network data, supporting recruitment efforts, and collaborating on negotiations as needed.

Responsibilities

• Negotiates, executes, reviews, and analyzes contracts and/or handles dispute resolution and settlement negotiations with solo, small group, or local providers, including SCAs, LOAs, and PPAs.
• Manages contract performance in support of network quality, availability, and financial goals and strategies.
• Recruits providers to ensure attainment of network expansion and adequacy targets.
• 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.
• Identifies and makes recommendations to manage cost issues and supports cost-saving initiatives and/or settlement activities.
• Provides 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.
• Optimizes interaction with assigned providers and internal business partners to manage relationships and ensure provider needs are met.
• Ensures resolution of escalated issues related to claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.
• Interprets contractual requirements including federal and state regulations and NCQA.

Required Qualifications

• 5+ years of working knowledge of the healthcare industry, including competitor strategies, complex contracting options, financial and contracting arrangements, and regulatory requirements.
• 3+ years of experience in provider relationship management or related healthcare roles, with proven and proficient contract management skills.
• Strong communication, critical thinking, problem-resolution, and interpersonal skills.
• Proficiency in Microsoft Office Suite (e.g., Excel, Word, PowerPoint, Outlook).

Preferred Qualifications

• Candidates residing on the West Coast are strongly preferred.

Education

Bachelor's degree preferred or a combination of professional work experience and education.

Schedule

Anticipated Weekly Hours: 40
Time Type: Full time

Pay

The typical pay range for this role is $60,300.00 - $132,600.00. 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.

Benefits

This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments.