Behavioral Health Provider Contract Negotiation Manager, CVS Health

Behavioral Health Provider Contract Negotiation Manager

CVS Health

Location:

United States, Work At Home, Georgia

Category:

Health and Beauty

Contract Type:

Employment contract

Salary:

54300.00 - 119340.00 USD / Year

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Job Description:

The Contract Negotiation Manager will negotiate and execute high-level review and analysis, manage dispute resolution and settlement negotiations of contracts with single and group Behavioral Health providers within a defined market. You will manage contract performance and support the development and implementation of strategic, traditional contracts and value-based contract relationships.

Job Responsibility:

Negotiates, executes, reviews, and analyzes contracts and/or handles dispute resolution and settlement negotiations with solo and group Behavioral Health providers for all lines of business (Medicare, commercial etc.)
Manages contract performance in support of network quality, availability, and financial goals and strategies for all lines of business (Medicare, commercial etc.)
Recruits Behavioral Health providers as needed to ensure attainment of network expansion and adequacy targets for all lines of business (Medicare, commercial etc.)
Collaborates cross-functionally to contribute 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
Responsible for identifying and making recommendations to manage cost issues and supporting cost saving initiatives and/or settlement activities
Provides Behavioral Health network development, maintenance, and refinement activities and strategies in support of cross-market network management unit
Assists with the design, development, management, and or implementation of strategic network configurations, including integration 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

Requirements:

Minimum 3+ years related experience, proven and proficient managed care network negotiating skills
Proven working knowledge of competitor strategies, complex contracting options, financial/contracting arrangements, and regulatory requirements
Strong and persuasive communication skills, especially written communications, with external stakeholders
Strong critical thinking, problem resolution and interpersonal skills
Adept at execution and delivery (planning, delivering, and supporting) skills
A ready business acumen and the ability to balance and articulate competing priorities while making decisions
Adept at collaboration and teamwork

Nice to have:

Versed with the Georgia Behavioral Health provider market
3-5 years related experience Commercial HMO, PPO products knowledge
3-5 years related experience Medicare and/or Medicaid products knowledge

What we offer:

Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs including wellness screenings, tobacco cessation, and weight management programs
Confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:

March 19, 2025

Expiration:

April 30, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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