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.
Position Summary
Contracting
Negotiates, executes, reviews, and analyzes contracts and/or handles dispute resolution and settlement negotiations focused on health systems in Indiana.
Manages contract performance
Contributes 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.
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.
Network Performance/Oversight
Recruits’ providers as needed to ensure attainment of network expansion and adequacy targets.
Responsible for identifying and making recommendations to manage cost issues and supporting cost saving initiatives and/or settlement activities.
Assists with the design, development, management, and/or implementation of strategic network configurations
Required Qualifications
Must reside in Indiana
Minimum 7+ years related experience and comprehensive level of negotiating with individual or complex provider systems or groups.
Knowledge of Indiana provider systems and market landscape.
Required to communicate w/internal/external parties by phone/in person; minimal travel to offsite provider groups and/or health system locations
Related experience in health operations, network relations and development, command of financials and pricing strategies, and sales interface.
Experience building and maintaining relationships with provider systems.
A successful track record managing and negotiating major provider contracts (move up)
In depth knowledge of various reimbursement structures and payment methodologies for both hospitals and providers/providers.
Preferred Qualifications
Knowledge and experience with value-based contracting and accountable care models.
In-depth knowledge of managed care business, regulatory /legal requirements.
Medicare Advantage knowledge and experience
Education
Bachelor's degree preferred/specialized training/relevant professional qualification
Pay Range
The typical pay range for this role is:
$67,900.00 - $149,328.00
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.