Job Description

Locations

• IN - Work from home

Skills Required

• provider relationsintermediate
• problem-solving techniquesintermediate
• Commercialintermediate

Required Qualifications

• 5+ years of experience in provider relations, contracting or managed care environment. (experience, 5 years)
• Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills with proven ability to influence and collaborate with providers and partners at all levels. (experience)
• Strong knowledge and experience in problem-solving techniques. (experience)
• Highly organized with strong prioritization skills; able to manage multiple negotiations and competing priorities while meeting deadlines. (experience)
• Candidates must reside in the state of Indiana. (experience)
• Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills with proven ability to influence and collaborate with providers and partners at all levels. (experience)
• Strong knowledge and experience in problem-solving techniques. (experience)
• Highly organized with strong prioritization skills; able to manage multiple negotiations and competing priorities while meeting deadlines. (experience)

Preferred Qualifications

• Experience with Commercial and Medicare lines of business. (experience)

Responsibilities

• This is an individual contributor role.
• Manages contract performance, and drives the development and implementation contract relationships in support of business strategies.
• Recruits providers as needed to ensure attainment of network expansion and adequacy targets. Accountable for cost arrangements within defined groups.
• 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.
• Responsible for identifying and managing cost issues and collaborating cross functionally to execute significant cost saving initiatives.
• Represents company with providers, groups and health systems.
• Promotes collaboration with internal partners.
• Evaluates, helps formulate, and implements the provider network strategic plans to achieve contracting targets and manage medical costs through effective provider contracting to meet state contract and product requirements. Collaborates with internal partners to assess effectiveness of tactical plan in managing costs.
• May optimize interaction with assigned providers and internal business partners to facilitate 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.
• Manages contract performance, and drives the development and implementation contract relationships in support of business strategies.
• Recruits providers as needed to ensure attainment of network expansion and adequacy targets. Accountable for cost arrangements within defined groups.
• 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.
• Responsible for identifying and managing cost issues and collaborating cross functionally to execute significant cost saving initiatives.
• Represents company with providers, groups and health systems.
• Promotes collaboration with internal partners.
• Evaluates, helps formulate, and implements the provider network strategic plans to achieve contracting targets and manage medical costs through effective provider contracting to meet state contract and product requirements. Collaborates with internal partners to assess effectiveness of tactical plan in managing costs.
• May optimize interaction with assigned providers and internal business partners to facilitate 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.

Benefits

• general: 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.
• general: 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.
• general: We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
• general: Additional details about available benefits are provided during the application process and on Benefits Moments.
• general: Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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