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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.
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- 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.
- 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
- Work from home locations are in PST including CA., UT, or ID
- Versed with the California/Utah/Idaho region Behavioral Health provider market highly preferred
- 3-5 years related experience Commercial HMO, PPO products knowledge
- 3-5 years related experience Medicare and/or Medicaid products knowledge
- Ideal candidate will reside in Central, Mountain or Pacific Time Z
- Bachelor's degree preferred/specialized training/relevant professional qualification.
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.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit Benefits | CVS Health
We anticipate the application window for this opening will close on: 12/31/2024
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.