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Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Position Summary

Contracting

· Negotiates, executes, reviews, and analyzes contracts and/or handles dispute resolution and settlement negotiations

· 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 5 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:

$75,400.00 - $166,000.00

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. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 06/23/2024

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.