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Position Summary

Leading contracting efforts under the Retail Health division of CVS Health as Minute Clinic locations begin expanding into Primary Care. The Manager, Payer Relations designs, develops contracts, maintains, and enhances relationships with payers and clinically integrated networks which serve as contractual networks of care for members. Manages and maintains relationships with payers by negotiating contracts, evaluating provider performance, resolving issues or disputes, identifying network expansion opportunities, and collaborating with internal and external stakeholders.

• Acts as a top-level specialist in contract negotiations with payers, establishing reimbursement rates, terms, and conditions that align with business objectives and financial goals.
• Creates and maintains strong working relationships with payer representatives and key decision-makers, including addressing concerns or issues, and collaborating to identify opportunities for mutually beneficial results.
• Advises on the development of the organization's payer strategy by analyzing market trends, identifying emerging opportunities, and assessing payer landscape dynamics.
• Evaluates payer performance metrics, such as claims processing, reimbursement accuracy, and contract compliance, and identifies areas for improvement.
• Develops and executes payer agreements by collaborating with legal, finance, and operations to ensure all payer aspects are sufficiently addressed and advanced.
• Interfaces with internal stakeholders to ensure timely and accurate fee schedule implementations and educate stakeholders on terms and conditions of payer arrangement.
• Corrects conflicts, addresses grievances, and negotiates satisfactory resolutions of payer-related issues and disputes.
• Consults on industry trends, regulatory changes, and healthcare policy developments that could impact payer relations and reimbursement models.
• Provides continuous recommendations to senior leadership to guide decision-making and ensure alignment with the organization's strategic goals.

• Minimum 5 years work experience managing payer and/or provider contracting for fee for service and/or value-based contracting.
• Familiar with contract analytics, implementation, and ongoing contract management
• Proficient in Microsoft Office Products, specifically Excel
• Ability to think independently in a fast-paced environment where priorities change quickly.
• Adept at problem solving and decision-making skills.
• Adept at collaboration and teamwork
• Adept at growth mindset (agility and developing yourself and others) skills.
• Adept at execution and delivery (planning, delivering, and supporting) skills.
• Adept at business intelligence

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