We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Position Summary:
This is an individual contributor role.
The Senior Manager negotiates, executes, conducts high level review and analysis, dispute resolution and/or settlement negotiations of contracts. Works with larger and more complex, market/regional/national based groups/systems in accordance with company standards to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals and cost initiatives.
The Senior Manager will be responsible for contracting and implementing fee for service and value-based agreements with key physician groups, facilities, and ancillary providers to support commercial and individual exchange networks. This person will also work collaboratively with Aetna and CVS departments to identify initiatives to improve physician performance and quality of care provided to our members.
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.
What You’ll Do
- Lead end-to-end contract negotiations, execution, and analysis with a focus on hospital, physician groups, and smaller/local systems.
- Manage contract performance and drive the development and implementation of value-based arrangements aligned with organizational strategy.
- Identify, recruit, and onboard providers to meet network expansion and adequacy targets; accountable for delivering competitive and sustainable cost arrangements.
- Partner cross-functionally to support provider compensation strategy, pricing development, and reimbursement modeling.
- Analyze financial and operational data to identify cost-saving opportunities and execute initiatives that drive measurable impact.
- Serve as a key representative of the organization with providers, customers, and community stakeholders, strengthening partnerships and collaboration.
- Evaluate and contribute to provider network strategy, ensuring alignment with state requirements, product needs, and cost management objectives.
- Optimize provider engagement and resolve complex escalations related to claims, contract interpretation, and provider data accuracy.
Required Qualifications
- 7+ years of experience negotiating contracts with hospitals, facilities, and physician groups, including contract language development, rate proposal analysis, and identification of operational and financial improvement opportunities. Demonstrated ability to leverage competitive market data, financial metrics, and detailed analysis to secure favorable contract outcomes.
- 3+ years of experience in provider relationship management or related healthcare roles, with proven contract management expertise.
- Proven working knowledge of provider financial issues and competitor strategies, large/complex contracting options, financial/contracting arrangements, and regulatory requirements.
- Strong communication, critical thinking, problem resolution and interpersonal skills.
- Candidates must reside in the state of Illinois.
- 10% travel required.
Preferred Qualifications
- Commercial, individual exchange and Medicare experience.
- Experience contracting with hospital systems and groups.
- Advanced Excel experience including pivot tables and v-lookup function.
Education
- Bachelor's degree preferred or a combination of professional work experience and education.
Pay Range
The typical pay range for this role is:
$82,940.00 - $182,549.00
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.
