Description
We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.
At CVS Health, you'll be surrounded by colleagues who care deeply, innovate with purpose, hold themselves accountable and prioritize safety and quality in everything they do.
Job Summary Constructs negotiation, execution, review, and analysis of contracts. Delivers dispute resolution and settlement negotiations with providers. Ensures contract performance aligns with accessibility, compliance, quality, financial, and cost goals.
Key Responsibilities
- Develop, maintain, and enhance working relationships with physicians/providers and local network and patient management teams in the markets with Aetna.
- Establish and implement programs and innovative initiatives for the organisation to advance Contract Negotiations initiatives.
- Forecast changes within the Contract Negotiations industry, conduct business impact assessments, and develop modification strategies with the aid of process improvement methodologies.
- Integrate cross-functional collaboration to contribute to provider compensation and pricing development activities and recommendations for negotiations and reimbursement modeling activities.
- Determine recommendations to manage cost issues and support cost-saving initiatives and settlement activities.
- Assist in the management of network development, maintenance, and refinement activities and strategies in support of cross-market network management units.
- Coach more junior colleagues in techniques, processes, and responsibilities.
- Perform other duties and responsibilities as assigned by manager.
Requirements
- 5+ years of provider contracting, claims management, or patient management experience.
- 5+ years of experience working with or in a Claims environment.
- 5+ years of experience that includes ACAS and HRP claim platforms, products, and benefits; patient management, provider relations, or claims management.
Preferred Qualifications
- Experience with Aetna systems (SCM, Smart Front End, Rate Inquiry, Contract Inquiry).
Education
- Bachelor's degree preferred or a combination of professional work experience and education.
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.