Job Description

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 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 large PCP groups, pediatricians, advanced specialist groups, hospital based providers, ancillary providers, ambulatory surgical centers, 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 own the 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 auditing, building, and loading contracts, agreements, amendments and/or fee schedules in contract management systems per Aetna’s established policies. .∙ 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 Subject Matter Expert support for questions related to recruitment initiatives, contracting, provider issues/resolutions, related systems and information contained.∙ Provide guidance and share expertise to others on the team.∙ Understanding of Value Based contracting and negotiations∙ Manage high level projects and recruitment initiatives with interdepartmental resources and/or cross functional stakeholders.∙ May participates in JOC meetings.∙ Supports or assists with operational activities that may include, but are not limited to, database management and contract coordination.∙ 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.∙ Preparing reports and presenting these to leadership.∙ Engage with providers and quickly move the providers though contracting processes in order to ensure meeting network adequacy requirements.

Required Qualifications ∙ 5-10 years of network contracting/management experience.∙ Ability to travel as needed (up to 25% travel).∙ 5 years of proven knowledge of standard provider contracts, terms and language desired.∙ 5 years of solid negotiating and decision-making skills while executing national, regional, or market level strategies.∙ 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.∙ Demonstrated high proficiency with personal computer, mouse, keyboard and all MS Office suite applications (e.g., Outlook, Word, Excel, etc.). Preferred Qualifications ∙ Knowledge of Medicaid programs and related subject matter preferred.∙ Solid decision-making skills while executing national, regional, and market level strategies.∙ Ability to forge long-lasting relationship.∙ Possess critical thinking, problem resolution and interpersonal skills.∙ Ability to forge long-lasting relationship.∙ Must possess critical thinking, problem resolution and interpersonal skills.∙ Ability to identify and capitalize on opportunities to support program delivery.∙ Communication Skills - Strong communication skills (written, verbal and presentation).∙ Ability to forge long-lasting relationships with providers.∙ Highly organized and self-driven. Education .Bachelor's degree desired or equivalent work experience

Pay Range

The typical pay range for this role is:

$54,300.00 - $136,500.00

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. 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

CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health colleagues can initiate a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through myHR (1-888-694-7287, or through myLeave at myHR). If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.

This job was posted on Mon Oct 16 2023 and expired on Sat Oct 21 2023.

Minimum $54K /yr

$95K /yr Average

Maximum $137K /yr

Tasks

Review financial statements, sales or activity reports, or other performance data to measure productivity or goal achievement or to identify areas needing cost reduction or program improvement.

Direct and coordinate activities of businesses or departments concerned with the production, pricing, sales, or distribution of products.

Direct administrative activities directly related to making products or providing services.

Prepare staff work schedules and assign specific duties.

Monitor suppliers to ensure that they efficiently and effectively provide needed goods or services within budgetary limits.

Direct or coordinate financial or budget activities to fund operations, maximize investments, or increase efficiency.

Establish or implement departmental policies, goals, objectives, or procedures in conjunction with board members, organization officials, or staff members.

Perform personnel functions such as selection, training, or evaluation.

Plan or direct activities such as sales promotions that require coordination with other department managers.

Set prices or credit terms for goods or services based on forecasts of customer demand.

Manage the movement of goods into and out of production facilities to ensure efficiency, effectiveness, or sustainability of operations.

Perform sales floor work, such as greeting or assisting customers, stocking shelves, or taking inventory.

Develop or implement product-marketing strategies, including advertising campaigns or sales promotions.

Recommend locations for new facilities or oversee the remodeling or renovating of current facilities.

Implement or oversee environmental management or sustainability programs addressing issues such as recycling, conservation, or waste management.

Direct non-merchandising departments of businesses, such as advertising or purchasing.

Plan store layouts or design displays.

Skills

Reading Comprehension - Understanding written sentences and paragraphs in work related documents.

Active Listening - Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.

Writing - Communicating effectively in writing as appropriate for the needs of the audience.

Speaking - Talking to others to convey information effectively.

Critical Thinking - Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.

Active Learning - Understanding the implications of new information for both current and future problem-solving and decision-making.

Monitoring - Monitoring/Assessing performance of yourself, other individuals, or organizations to make improvements or take corrective action.

Social Perceptiveness - Being aware of others' reactions and understanding why they react as they do.

Coordination - Adjusting actions in relation to others' actions.

Persuasion - Persuading others to change their minds or behavior.

Negotiation - Bringing others together and trying to reconcile differences.

Instructing - Teaching others how to do something.

Service Orientation - Actively looking for ways to help people.

Complex Problem Solving - Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.

Judgment and Decision Making - Considering the relative costs and benefits of potential actions to choose the most appropriate one.

Time Management - Managing one's own time and the time of others.

Management of Financial Resources - Determining how money will be spent to get the work done, and accounting for these expenditures.

Management of Material Resources - Obtaining and seeing to the appropriate use of equipment, facilities, and materials needed to do certain work.

Management of Personnel Resources - Motivating, developing, and directing people as they work, identifying the best people for the job.

Knowledge

Administration and Management - Knowledge of business and management principles involved in strategic planning, resource allocation, human resources modeling, leadership technique, production methods, and coordination of people and resources.

Clerical - Knowledge of administrative and clerical procedures and systems such as word processing, managing files and records, stenography and transcription, designing forms, and other office procedures and terminology.

Economics and Accounting - Knowledge of economic and accounting principles and practices, the financial markets, banking and the analysis and reporting of financial data.

Sales and Marketing - Knowledge of principles and methods for showing, promoting, and selling products or services. This includes marketing strategy and tactics, product demonstration, sales techniques, and sales control systems.

Customer and Personal Service - Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.

Personnel and Human Resources - Knowledge of principles and procedures for personnel recruitment, selection, training, compensation and benefits, labor relations and negotiation, and personnel information systems.

Production and Processing - Knowledge of raw materials, production processes, quality control, costs, and other techniques for maximizing the effective manufacture and distribution of goods.

Computers and Electronics - Knowledge of circuit boards, processors, chips, electronic equipment, and computer hardware and software, including applications and programming.

Mathematics - Knowledge of arithmetic, algebra, geometry, calculus, statistics, and their applications.

English Language - Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.

Public Safety and Security - Knowledge of relevant equipment, policies, procedures, and strategies to promote effective local, state, or national security operations for the protection of people, data, property, and institutions.