Contract Processor Jobs in Seminole, FL (NOW HIRING)

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Position Summary

This is an individual contributor role.

This role will contract and manage provider negotiations with physicians and ancillary providers throughout the state.

• Manages contract performance and drives the development and implementation of value-based contract relationships in support of business strategies.
• Project management skills to prioritize competing priorities and effectively communicate provider contracting scenarios with attention to detail based on a thorough evaluation of provider data using internal tools.
• 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

• Minimum of 5 years of related experience, with demonstrated proficiency in managed care network negotiations.
• Minimum of 3 years of experience in provider relations, with demonstrated success in strengthening provider partnerships, increasing engagement, and contributing to network performance and access goals.
• Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint, Outlook).
• Candidates must reside in the state of Florida.

Preferred Qualifications

• Demonstrated ability to build and maintain strong, long-term relationships with provider partners.
• Demonstrated ability to communicate effectively across all levels of the organization, evidenced by successful cross-functional collaboration and the ability to influence provider and stakeholder decisions in complex situations.
• Proven track record of applying knowledge of competitor strategies, complex contracting models, and financial arrangements to support negotiations and achieve favorable contract outcomes while maintaining regulatory compliance.
• Working knowledge of Medicare programs and related regulatory and operational requirements.

Education

• Bachelor's degree preferred or a combination of professional work experienceand education.

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

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.

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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.