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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.
Position Summary
Negotiates, executes, conducts high level review and analysis of dispute resolution and/or settlement negotiations of contracts with larger and more complex, market/regional/national based group/system providers including but not limited to individual and group behavioral health providers, etc. in accordance with company standards in order to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals and cost initiatives.
Recruit providers as needed to ensure attainment of network expansion goals, achieve regulatory and/or internal adequacy targets.
Support health plan with expansion initiatives or other contracting activities as needed
Initiates, coordinates and owns contracting activities to fulfillment including receipt and processing of contracts and documentation and pre- and post-signature review of contracts and language modification according to Aetna’s established policies.
Responsible for building, and loading contracts, agreements, amendments, and/or fee schedules in contract management systems per Aetna established policies.
Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities.
Provides Subject Matter Expertise for questions related to recruitment initiatives, contracting, provider issues/resolutions, related systems and information contained.
Engage with providers and move quickly through contracting processes to ensure network adequacy standards are met.
Required Qualifications
3-5 years of network contracting/management experience.
3-5 years of solid negotiating and complex decision-making skills while executing national, regional, or market level strategies.
In-depth knowledge of the managed care industry and practices.
Working knowledge of behavioral health topics related to managed care plans.
Detail-oriented with strong communication, analytical and negotiation skills.
Ability to build collaborative relationships with providers work cross-functionally to resolve complex provider contract issues
Demonstrated high proficiency with MS Office suite applications (e.g., Outlook, Word, Excel, etc.)
Ability to work remote in Central time zone
Preferred Qualifications
Health plan experience supporting behavioral health provider networks.
General knowledge of reporting tools for contract financial analysis and modeling.
Solid decision-making skills while executing national, regional and market level strategies.
Possess critical thinking, issue resolution and interpersonal skills.
Strong communication skills (written, verbal and presentation).
Highly organized and self-driven.
Contract negotiations experience in the Colorado market
Education
Bachelor's degree desired or equivalent work experience.
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$54,300.00 - $145,860.00
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.
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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan .
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on: 05/25/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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.