Provider Network Manager Jobs in Illinois (NOW HIRING)

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Position Summary Negotiates, executes, and analyzes contracts with larger and more complex healthcare group/system providers, focusing on maintaining and enhancing the provider network while meeting accessibility, quality, and financial goals. Handles dispute resolution and settlement negotiations, ensuring compliance with company standards and regulatory requirements. Leverages extensive negotiation skills and working knowledge of provider financial issues to optimize contracts, and collaborates with large hospitals and health systems to achieve successful contracting outcomes, all while supporting cost-saving initiatives and the growth of the provider network.

• Negotiates, executes, and conducts high-level review and analysis of contracts with larger and more complex group/system providers while ensuring contracts align with company standards and goals related to accessibility, quality, and financial performance.

• Manages and facilitates dispute resolution processes to address issues arising from provider contracts, ensuring equitable solutions.

• Leads contract settlement negotiations, striving to reach mutually beneficial agreements with providers that maintain and enhance the provider network.

• Implements strategies to enhance and expand the provider network, while ensuring it meets accessibility and quality standards.

• Aligns provider contracts with financial goals and cost-saving initiatives, ensuring that contracts support the company's financial objectives.

• Conducts comprehensive reviews and analyses of provider contracts, identifying areas for improvement and optimization.

• Ensures that all provider contracts adhere to regulatory requirements, maintaining compliance with healthcare regulations.

• Utilizes working knowledge of provider financial issues and competitor strategies to inform negotiation and contracting decisions.

• Facilitates leadership, guidance, and mentorship to a team of professionals by setting strategic objectives, monitoring team performance, providing training and development opportunities, and fostering a collaborative and innovative work environment.

Required Qualifications

• A minimum 7 years of experience contracting with providers within the healthcare industry.

• A minimum 5 years of direct hospital contracting experience.

• Experience with Commercial, Medicare, and Medicaid lines of business.

• Adept at problem solving and decision making skills, based on data and trends.

• Adept at collaboration and teamwork

• Addition skills include agrowth mindset (agility and developing yourself and others) skills;execution and delivery (planning, delivering, and supporting) skills;business intelligence andcommunication skills across multiple levels of leadership.

• Ability to travel within assigned territory if needed

Preferred Qualifications

• Strong understanding of the IL and MO market, including local payer and provider dynamics.

• Hands-on experience with value-based contracting and alternative payment arrangements.

Education

• Bachelor's degree or a combination of professional work experience and education.

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. 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 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.