Senior Provider Network Contracting (MA/RI)

Company: Hispanic Alliance for Career Enhancement
Location: San Jose
Posted on: June 1, 2025

Job Description:

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

• Guides development of holistic solutions or strategic plans negotiates and executes contracts with the most complex, market /region/national, largest group/system or highest value/volume of spend providers with significant financial implications.
• Manages contract performance, and drives the development and implementation of value based 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 high visibility constituents, including customers and community groups. 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.
  
  Required Qualifications
  
  • Critical thinking to maintain cost management and a fully engaged network of participating hospitals, ancillaries and providers.
  • A minimum of 5 years related experience and comprehensive level of negotiating skills with successful track record negotiating contracts with hospitals.
  • Understanding knowledge of Value Based Contracting.
  • Microsoft Office/Excel proficient
    
    Preferred Qualifications
    
    • Healthcare Industry experience with either a payer or provider
    • Strong communication, critical thinking, problem resolution and interpersonal skills.
    • Internal Aetna system knowledge a plus.
    • Understanding of Medicare & Commercial.
    • Proven working knowledge of provider financial issues and competitor strategies, complex contracting options, financial/contracting arrangements and regulatory requirements.
      
      Education
      
      • Bachelor's Degree preferred or a combination of professional work experience and education.
        
        Pay Range
        
        The typical pay range for this role is:
        
        $75,400.00 - $182,549.00
        
        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. This position also includes an award target in the company's equity award program.
        
        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.
        
        Great benefits for great people
        
        We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
        
        • Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
        • No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
        • Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
          
          For more information, visit https://jobs.cvshealth.com/us/en/benefits
          
          We anticipate the application window for this opening will close on: 05/31/2025
          
          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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Keywords: Hispanic Alliance for Career Enhancement, Arden-Arcade , Senior Provider Network Contracting (MA/RI), Other , San Jose, California