Contract Negotiation Manager - Texas Medicaid

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.

In this Texas Medicaid individual contributor role the contract negotiator :

• Negotiates competitive contracts with health care providers using pre-determined internal guidelines and financial standards.
• Negotiates contract language in accordance with Aetna standards, engaging other departments as needed for review and approval of contract terms outside the standards.
• Conducts competitive and financial analyses to achieve best in market discounts and financial results that are within pre-determined targets.
• Manages contract performance and works with various internal departments to address questions, issues, and activities related to execution, loading, and ongoing maintenance of provider contracts.
• Negotiates and supports the implementation of value-based contract relationships in support of business strategies.
• Manages relationships with key providers and ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.
• Negotiates settlements as needed. May recruit providers as needed to ensure network adequacy and achievement of network expansion goals.

Maintains accountability for specific medical cost initiatives.

Candidates should reside in Texas (Dallas / Ft Worth, Houston, Austin and San Antonio)

Required Qualifications

3+ years of experience negotiating contracts with ancillary providers, physician groups, and IPAs, including contract language, development, and analysis of rate proposals, identifying operational and financial improvement opportunities, and collection and analysis of competitive data and key financial metrics.

Uses competitive and financial data, as well as analysis detail, to negotiate favorable contracts.

3+ years of working knowledge of complex contracting options, provider reimbursement methodologies and terms, and contract setup.

Understanding of provider financial issues, industry standard payment policies, regulatory requirements, and competitor strategies.

Must be proficient in Word, Excel, and Microsoft Office.

Preferred Qualifications

• Medicaid contracting experience.
• Strong critical thinking, problem resolution, organization, communication, and interpersonal skills.
• Able to successfully manage multiple negotiations, issues, and other tasks to ensure completion and meet deadlines.
• Able to manage expectations and maintain strong relationships, both internally and externally.
• Experience negotiating and / or managing value-based contracts brings added value.

Education

Bachelor’s Degree or equivalent combination of education and professional work experience.

Pay Range

The typical pay range for this role is :

$60,300.00 - $132,600.00

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.