Provider Network Contracting- LTSS (Pennsylvania)

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

Negotiates, executes, conducts high level review and analysis, dispute resolution and/or settlement negotiations of contracts with larger and more complex, market/regional/national based group/system providers 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. Responsible for assisting in the reviewing, building and auditing complex contracts and network data, support recruitment efforts, and collaborate on negotiations as needed.

What you will do

• Recruit providers as needed to ensure attainment of network expansion and adequacy targets and in support of network management and expansion initiative or analyze market data for outreach mailings to desired expansion targets Initiates and coordination of moderate contracting activities, including the implementation, receipt and processing of contracts and documentation and pre-and post-signature review of contracts and language modification.

• Negotiates and executes, conducts moderate level review and analysis, dispute resolution and/or settlement negotiations of contracts with larger and more complex, market-based, group/system providers. May recruit providers in support of network management and expansion initiative or analyze market data for outreach mailings to desired expansion targets.

• Responsible for auditing, building, and loading contracts, agreements, amendments and/or fee schedules in contract management systems.

• Conducts research, analysis and/or audits to identify issues and propose solutions to protect data, contract integrity and performance.

• Manages contract performance and supports the development and implementation of value-based contract relationships in support of business strategies.

• 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 technical expertise for questions related to contracting and related systems and information contained.

• Collaborates on negotiations or may handle contracting and re-contracting discussions with solo providers or small groups.

• May participates in JOC meetings.

• Supports or assists with operational activities that may include, but are not limited to, database management and contract coordination.

• Developing and maintaining databases, data systems – reorganizing data in a readable format.

• Performing analysis to assess quality and meaning of data Using data mining to extract information from data sets and identify correlations and patterns.

• Organizing and transforming information into comprehensible structures.

• Using data to predict trends in the customer base and the consumer population as a whole Performing statistical analysis of data Using tools and techniques to visualize data in easy-to-understand formats, such as diagrams and graphs

Required Qualifications

• A minimum of 3 years related experience of basic negotiating skills desired.

• Proven working knowledge of standard provider contracts, terms and language desired.

• Demonstrated high proficiency with personal computer, mouse, keyboard and all MS Office suite applications (e.g., Outlook, Word, Excel, etc.).

• Strong communication skills (written, verbal and presentation).

• Must possess critical thinking, problem resolution and interpersonal skills.

Preferred Qualifications

• Ability to identify and capitalize on opportunities to support program delivery.

• In-depth knowledge of the managed care industry and practices, as well as a strong understanding of Aetna competitor strategies, practices, and financial/contracting arrangements.

Education

• Bachelor's degree desired or equivalent professional work experience.

Pay Range

The typical pay range for this role is:

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. 
 
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

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Salary : $60,300 - $132,600