Manager, Provider Contract Negotiation (Georgia)

About the role

Entry-level contracting role for a candidate with minimal contracting experience and background. Project management skills to prioritize competing priorities, effectively communicate provider contracting scenarios with attention to detail based on a thorough evaluation of provider data using internal tools, and support and manage assigned projects for the market.

Manages contract performance and drives the development and implementation of value-based contract relationships in support of business strategies. Recruits providers as needed to ensure attainment of network expansion and adequacy targets. Accountable for cost arrangements within defined providers.

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. Responsible for identifying and managing cost issues and collaborating cross-functionally to execute significant cost-saving initiatives.

Represents the company with high-visibility constituents, including customers and community groups. Promotes collaboration with internal partners. Evaluates, helps formulate, and implements the provider network strategic plans to achieve contracting targets and manage medical costs through effective provider contracting to meet state contract and product requirements. Collaborates with internal partners to assess the effectiveness of tactical plans in managing costs.

May optimize interaction with assigned providers and internal business partners to facilitate 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.

Responsibilities

• Prioritize competing priorities and manage projects for the market.
• Develop and implement value-based contract relationships.
• Recruit providers to ensure network expansion and adequacy targets.
• Manage provider compensation and pricing development activities.
• Review and analyze reports for negotiation and reimbursement modeling.
• Identify and manage cost issues, executing cost-saving initiatives.
• Represent the company with customers and community groups.
• Evaluate and implement provider network strategic plans.
• Collaborate with internal partners to manage costs effectively.
• Optimize interactions with providers and resolve escalated issues.

Requirements

• 5+ years of experience in provider relations, contracting, or a managed care environment.
• Knowledge of the managed care industry, practices, and financial/contracting arrangements.
• Critical thinking, problem resolution, organizational, and interpersonal skills.
• Highly organized and self-driven.
• Must reside in Georgia and be able to drive to the Atlanta office location once per month.

Qualifications

• Bachelor’s degree and relevant training or work experience.

Preferred Qualifications

• Ability to forge meaningful, long-lasting relationships with providers.
• Physician, ancillary, and/or commercial experience.
• Knowledge of Medicare programs and related subject matter.

Pay

The typical pay range for this role is $54,300.00 - $119,340.00 annually. This position is also eligible for a CVS Health bonus, commission, or short-term incentive program in addition to the base pay range.

Schedule

• Full-time, 40 hours per week.

Benefits

This full-time position is eligible for a comprehensive benefits package, including:

• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources.