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Georgia, United States
Remote only
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 passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
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.
Develop, maintain, and enhance working relationships with physicians/providers and local network and patient management teams in the markets with Aetna.
Establishes and implements programs and innovative initiatives for the organization to advance Contract Negotiations initiatives.
Forecasts changes within the Contract Negotiations industry, conducts business impact assessments, and develops modification strategies with the aid of process improvement methodologies.
ntegrates cross-functional collaboration to contribute to provider compensation and pricing development activities and recommendations for negotiations and reimbursement modeling activities.
Determines recommendations to manage cost issues and support cost-saving initiatives and settlement activities.
Assists in the management of network development, maintenance, and refinement activities and strategies in support of cross-market network management units.
Coaches more junior colleagues in techniques, processes, and responsibilities.
Other duties and responsibilities as assigned by manager.
Required Qualifications
5+ years of provider contracting, claims management, or patient management experience.
5+ experience working with/or in a Claims environment
5+ experience that includes ACAS and HRP claim platforms, products, and benefits; patient management, provider relations, or claims management.
Preferred Qualification
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.
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$54,300.00 - $159,120.00This 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.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
