Provider Contract Negotiation Manager
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Job Description
Remote Provider Contract Negotiation Manager negotiating provider contracts and settlements for CVS Health. Managing cost, compliance, quality, and accessibility goals across Aetna markets.
Responsibilities:
- Negotiate single case agreements for episodes of care on a pre-service basis
- Analyze forecast changes within the Contract Negotiations industry
- Develop business impact assessments and modification strategies using process improvement methodologies
- Recommend approaches to manage cost issues and support cost-saving initiatives and settlement activities
- Develop, maintain, and enhance relationships with physicians/providers and local network and patient management teams in Aetna markets
- Coach more junior colleagues in techniques, processes, and responsibilities
- Collaborate cross-functionally with internal teams to support and manage negotiations
- Construct, execute, review, and analyze contracts
- Deliver dispute resolution and settlement negotiations with providers
- Ensure contract performance aligns with accessibility, compliance, quality, financial, and cost goals
Requirements:
- 5+ years of experience in provider contracting, claims management, or patient management
- 2+ years of experience in claims operations or a related claims management environment
- 1–2 years of experience working with ACAS and HRP claims platforms, products, and benefits, as well as patient management, provider relations, or claims management
- Knowledge/experience with National Advantage Program within Aetna preferred
- Working knowledge of Aetna systems and tools, including Smart Front End, ASD, HRP, MedCompass, and RUMBA applications (EPDB, EWMP, Rate Inquiry, and Contract Inquiry)
- Bachelor's degree preferred or a combination of professional work experience and education
- Ability to work remotely from one of the listed U.S. locations
Benefits:
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being
- CVS Health bonus, commission or short-term incentive program in addition to base pay
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