PA - Work from home, United States of America
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.
**The candidate must sit in PA or DE states**
Position Summary
Negotiates, executes, and conducts high-level review and analysis, dispute resolution, and settlement negotiations of contracts with large, complex provider systems. Maintains and enhances provider networks while meeting accessibility, quality, and financial goals, and supports cost-saving initiatives in alignment with company standards and regulatory requirements.
Key Responsibilities
Negotiate, execute, and analyze complex provider contracts, including dispute resolution and settlement negotiations
Manage contract performance and support value-based arrangements aligned to business strategy
Drive network expansion and adequacy through provider recruitment and targeted strategies
Accountable for cost arrangements and aligning contracts with financial goals
Collaborate cross-functionally on pricing, compensation, and reimbursement modeling activities
Conduct contract analysis to identify cost savings and optimization opportunities
Resolve escalated issues including claims, contract interpretation, and provider data accuracy
Ensure compliance with regulatory requirements and company standards
Serve as SME and provide guidance to team members
Support network development and strategic configuration initiatives
Required Qualifications
7–10 years of experience in healthcare contracting or network management
Strong understanding of provider financials and reimbursement methodologies
Proven negotiation, communication, and cross-functional collaboration skills
Familiarity with the Keystone market preferred
Preferred Qualifications
Experience working with Aetna internal systems preferred
Strong proficiency in Microsoft Office applications
Background in value-based care agreements
Experience across Commercial, Medicare, and Medicaid lines of business
Education
Bachelor’s Degree preferred or a combination of professional work experience and education.
Pay Range
The typical pay range for this role is:
$75,400.00 - $165,954.00
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. This position also includes an award target in the company’s equity award program.
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.
Want to know if this job is worth applying to?
