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Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
Position Summary
Negotiate and maintain a broad portfolio of physician contracts in Northern CA. Responsible for negotiation, execution, review, and analysis of contracts. Facilitate dispute resolution and settlement negotiations with providers, as applicable. Ensures contract performance aligns with organizational goals related to; accessibility, compliance, quality, and affordability.
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Position Summary
- Negotiates, executes, reviews, and analyzes fee-for-service contracts and/or handles dispute resolution and settlement negotiations with physician groups in the California market; for lines of business (Medicare and Commercial).
- Manages contract performance in support of network quality, availability, and financial goals and strategies for all lines of business.
- Recruits providers as needed to ensure attainment of network expansion and adequacy targets for all lines of business.
- 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 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.
- 5+ years of related experience, proven and proficient managed care network negotiating skills.
- Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills with proven ability to influence and collaborate with providers and partners at all levels.
- Proven working knowledge of competitor strategies, complex contracting options, financial/contracting arrangements, and regulatory requirements.
- Must be well versed with the provider relations.
- Provider Data Management
- Claim and/or Customer Service Experience
- Preference for this candidate to reside within or have experience in the northern California market
- Bachelor's Degree or equivalent professional work experience.
The typical pay range for this role is:
$66,330.00 - $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: 11/30/2024
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.