Contract Manager, Network Management

Job Description Negotiates, executes, conducts high level review and analysis of dispute resolution and/or settlement negotiations of contracts with larger and more complex, market/regional/national based group/system providers including but not limited to large PCP groups, pediatricians, advanced specialist groups, hospital based providers, ancillary providers, ambulatory surgical centers and behavioral health providers in accordance with company standards in order to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals and cost initiatives. Recruit providers as needed to ensure attainment of network expansion goals, achieve regulatory and/or internal adequacy targets. Support health plan with expansion initiatives or other contracting activities as needed. Initiates, coordinates contracting activities including the implementation, receipt and processing of contracts and documentation and pre- and post-signature review of contracts and language modification, according to Aetna's established policies. Responsible for auditing, building, and loading contracts, agreements, amendments and/or fee schedules in contract management systems per Aetna's established policies. . Conducts research, analysis and/or audits to identify issues and propose solutions to protect data, contract integrity and performance. Manages contract performance and supports the development and implementation of value-based contract relationships in support of business strategies. 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. Provides subject matter expert support for questions related to recruitment initiatives, contracting, provider issues/resolutions, the related systems and information contained. May participates in JOC meetings. Supports or assists with operational activities that may include, but are not limited to, database management and contract coordination. Organizing and transforming information into comprehensible structures. Using data to predict trends in the customer base and the consumer population as a whole Performing statistical analysis of data. Using tools and techniques to visualize data in easy-to-understand formats, such as diagrams and graphs. Preparing reports and presenting these to leadershipPay RangeThe typical pay range for this role is:Minimum: 60,300Maximum: 126,600Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required Qualifications 5-7 years of network management experience. Ability to travel as needed (up to 25% travel). 5 years of working knowledge of standard provider contracts, terms and language desired. Demonstrated high proficiency with personal computer, mouse, keyboard and all MS Office suite applications (e.g., Outlook, Word, Excel, etc.). 5 years of knowledge of the managed care industry and practices, as well as a strong understanding of strategies, practices, and financial/contracting arrangements. 5 years of negotiating skills. 5 years of decision-making skills while executing national, regional, and market level strategies.Preferred Qualifications Expertise in provider contracts, contracting options, contract language and rate guidelines as well as provider configurations. Ability to identify and capitalize on opportunities to support program delivery. Communication Skills - Strong communication skills (written, verbal and presentation). Ability to forge long-lasting relationship. Must possess critical thinking, problem resolution and interpersonal skills.Education Bachelor's degree desired or equivalent work experience.Business OverviewBring 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. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We 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.

Created: 2025-11-15