Negotiates, executes, reviews, and analyzes contracts and/or handles dispute resolution and settlement negotiations with smaller providers ( (i.e. local, individual providers, small groups/systems) in accordance with company standards in order to maintain and enhance provider networks while meeting and exceeding accessibility, compliance, quality, and financial goals and cost initiatives.
- Negotiates, executes, reviews, and analyzes contracts and/or handles dispute resolution and settlement negotiations with solo, small group, or local providers
- Manages contract performance in support of network quality, availability, and financial goals and strategies
- Recruits providers as needed to ensure attainment of network expansion and adequacy targets
- 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
- Proven working knowledge of competitor strategies, complex contracting options, value based contracting, financial/contracting arrangements and regulatory requirements
- 3-5 years related experience, proven and proficient negotiating skills
- Strong communication, critical thinking, problem resolution and interpersonal skills
- Bachelor's Degree or equivalent combination of education and experience
Associate's degree or equivalent experience
Percent of Travel Required
0 - 10%
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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