Contract Negotiator Manager - Providers

Recruits providers as needed to ensure network adequacy and achievement of network expansion goals. Negotiates contracts with health care providers using pre-determined internal guidelines and financial standards. Uses various sources of competitive intel to negotiate best in market discounts. Develops rate proposals and performs financial analyses to ensure that results are within pre-determined targets. Negotiates contract language in accordance with Aetna standards, engaging other departments as needed for review and approval of contract terms outside the standards. Responsible for building contracts and amendments in contract management system in accordance with Aetna established guidelines, obtaining signatures, monitoring their progress post-signature, and verifying their accuracy post-release. Manages contract performance and works with various internal departments to address questions, issues, and activities related to execution, loading, and ongoing maintenance of provider contracts. Supports the negotiation and implementation of value-based contract relationships in support of business strategies. Manages relationships with key providers and ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information. Negotiates settlements as needed. Responsible for identifying and making recommendations to manage cost issues and supporting cost saving initiatives.

• Recruits providers as needed to ensure network adequacy and achievement of network expansion goals.
• Negotiates contracts with health care providers using pre-determined internal guidelines and financial standards.
• Uses various sources of competitive intel to negotiate best in market discounts.
• Develops rate proposals and performs financial analyses to ensure that results are within pre-determined targets.
• Negotiates contract language in accordance with Aetna standards, engaging other departments as needed for review and approval of contract terms outside the standards.
• Responsible for building contracts and amendments in contract management system in accordance with Aetna established guidelines, obtaining signatures, monitoring their progress post-signature, and verifying their accuracy post-release.
• Manages contract performance and works with various internal departments to address questions, issues, and activities related to execution, loading, and ongoing maintenance of provider contracts.
• Supports the negotiation and implementation of value-based contract relationships in support of business strategies.
• Manages relationships with key providers and ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.
• Negotiates settlements as needed.
• Responsible for identifying and making recommendations to manage cost issues and supporting cost saving initiatives.

• 3+ years of experience negotiating contracts with ancillary providers, facilities, physician groups, and IPAs, including contract language, development and analysis of rate proposals, identifying operational and financial improvement opportunities, and collection and analysis of competitive data and key financial metrics.
• Understanding of common contract provisions, provider reimbursement methodologies and terms, and industry standard payment policies and practices.
• Understanding of provider financial issues, regulatory requirements, and competitor strategies.
• Detail-oriented with strong communication, analytical and negotiation skills.
• Able to manage expectations and maintain strong relationships, both internally and externally.
• Ability to build collaborative relationships with providers and work cross-functionally to resolve complex provider contract issues.
• Highly organized and able to successfully manage and prioritize multiple negotiations, issues, and other tasks to ensure completion and meet deadlines.

• 401(k) plan
• Employee stock purchase plan
• No-cost programs for all colleagues
• Paid time off
• Flexible work schedules
• Family leave
• Dependent care resources
• Colleague assistance programs
• Tuition assistance
• Retiree medical access

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.