Negotiates competitive and complex contracts with health care providers using pre-determined internal guidelines and financial standardsNegotiates contract language in accordance with aetna standards, engaging other departments as needed for review and approval of contract terms outside the standardsConducts competitive and financial analyses to achieve best in market discounts and financial results that are within pre-determined targetsManages contract performance and works with various internal departments to address questions, issues, and activities related to execution, loading, and ongoing maintenance of provider contracts.
Supports the development and implementation of value-based contract relationships in support of business strategiesManages 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 informationNegotiates settlements as neededMay recruit providers as needed to ensure network adequacy and achievement of network expansion goalsMaintains accountability for specific medical cost initiativesServes as sme for less experienced team members and internal partners.
5+ years of experience negotiating contracts with hospitals, as well as ipas, phos, and other large health care providers, 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.
Working knowledge of complex contracting options, provider reimbursement methodologies and terms, and contract setup.
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.
Covid-19 vaccination requirement
Cvs health requires its colleagues in certain positions 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, pregnancy, or religious belief that prevents them from being vaccinated.
If you are 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 within the first 30 days of your employmentFor the two covid-19 shot regimen, you will be required to provide proof of your second covid-19 shot within the first 60 days of your employmentFailure to provide timely proof of your covid-19 vaccination status will result in the termination of your employment with cvs health.
If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with cvs healthAs a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinatedIf your request for an accommodation is not approved, then your employment may be terminated.
5-8 years of experience negotiating contracts with hospitals, as well as ipas, phos, and other large health care providers, 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.
Understanding of provider financial issues, industry standard payment policies, regulatory requirements, and competitor strategies.
Experience negotiating and/or managing value-based contracts brings added value.
Medicaid contract knowledge
Bachelors degree or equivalent work experience.
At aetna, a cvs health company, we are joined in a common purpose: helping people on their path to better healthWe are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focusedWorking together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplaceCvs health is an equal opportunity and affirmative action employerWe do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran statusWe proudly support and encourage people with military experience (active, veterans, reservists and national guard) as well as military spouses to apply for cvs health job opportunities.