Provider Network Manager Jobs in Ohio (NOW HIRING)

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Position Summary

This is an individual contributor role.

Negotiates, executes, reviews, and analyzes contracts and/or handles dispute resolution and settlement negotiations with smaller providers (i.e., local individual providers and small groups/systems). Supports larger provider partners in accordance with company standards to maintain and enhance provider networks while meeting or exceeding accessibility, compliance, quality, and financial goals, as well as cost initiatives.

What You Will Do

• Negotiates, executes, reviews, and analyzes contracts and/or handles dispute resolution and settlement negotiations with solo, small group, or local providers.
• Manages contract performance in support of network quality, availability, and financial goals and strategies.
• Recruits providers as needed to ensure attainment of network expansion and adequacy targets.
• Collaborates cross-functionally to contribute to provider compensation and pricing development activities and recommendations, submits contractual information, and supports the review and analysis of reports as part of negotiation and reimbursement modeling activities.
• Identifies and recommends solutions to manage cost issues and supports cost-saving initiatives and/or settlement activities.
• Provides network development, maintenance, and refinement strategies in support of the cross-market network management unit.
• Assists with the design, development, management, and/or implementation of strategic network configurations, including integration activities.
• Experience with both fee-for-service and value-based contracting is preferred.
• Optimizes interactions with assigned providers and internal business partners to manage relationships and ensure provider needs are met.
• Ensures resolution of escalated issues related to, but not limited to, claims payment, contract interpretation and parameters, and the accuracy of provider contract or demographic information.
• Follows established procedures and protocols in completing standard contracts for providers.

Required Qualifications

• 5+ years of experience, based on education and professional background, negotiating contracts with ancillary providers, facilities, and physician groups. Expertise includes contract language development, rate proposal analysis, and identification of operational and financial improvement opportunities. Skilled in collecting and analyzing competitive data and key financial metrics to support negotiations and consistently secure favorable contract outcomes.
• 3+ years of experience in provider relationship management or related healthcare roles, with proven contract management skills.
• Understanding of common contract provisions, provider reimbursement methodologies and terms, and industry-standard payment policies and practices.
• Understanding of provider financial issues, regulatory requirements, and competitor strategies.
• Demonstrated proficiency with Microsoft Office suite applications (e.g., Outlook, Word, Excel).
• Ability to build collaborative relationships with providers and work cross-functionally to resolve complex contract issues.
• Highly organized, with the ability to manage and prioritize multiple negotiations, issues, and tasks to meet deadlines.

Preferred Qualifications

• Experience supporting the Medicaid line of business.
• Knowledge of mental health reimbursement structures and clinical care delivery models.
• Candidates residing in the state of Ohio.

Education

• Bachelor's degree 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.