Director Provider Network Development Jobs in Minnesota

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Position Summary:

This is an individual contributor role.

The Contract Manager serves as the subject matter expert in support of contracting initiatives and data audits to enhance provider networks while meeting and exceeding accessibility, compliance, quality, and financial goals. Responsible for reviewing, building and auditing complex contract and network data, support recruitment efforts, and collaborating on negotiations as needed.

Role/Responsibilities
Negotiates, executes, reviews, and analyzes contracts and/or handles dispute resolution and settlement negotiations with solo, small group, or local providers, including SCAs, LOAs, and PPAs.
Manages contract performance in support of network quality, availability, and financial goals and strategies.
Recruits providers to ensure attainment of network expansion and adequacy targets.
Collaborates cross-functionally to contribute to provider compensation and pricing development activities and recommendations, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities.
Responsible for identifying and making recommendations to manage cost issues and supporting cost saving initiatives and/or settlement activities.
Provides network development, maintenance, and refinement activities and strategies in support of cross-market network management unit.
Assists with the design, development, management, and or implementation of strategic network configurations, including integration activities.
May optimize interaction with assigned providers and internal business partners to manage 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.
Interprets contractual requirements including federal and state regulations and NCQA.

Required Qualifications:
5+ years of working knowledge in the healthcare industry, including competitor strategies, complex contracting options, value based contracting, financial and contracting arrangements, and regulatory requirements.
3+ years of experience in provider relationship management or related healthcare roles, with proven and proficient contract management skills.
Strong communication, critical thinking, problem resolution and interpersonal skills.

Preferred Qualifications:
Knowledge and/or experience in provider network contracting.
Proficiency in the Microsoft Office Suite.

Education:
Bachelor's degree preferred or a combination of professional work experience and 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.

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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.