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Position Summary

Leading contracting efforts under the Retail Health division of CVS Health, the Senior Manager, Payer Relations manages and optimizes relationships with payers which serve as the primary revenue source and access channel for MinuteClinic patients. This role manages relationships with payers by strategically negotiating contracts, evaluating payer performance, resolving issues or disputes, and collaborating with internal and external stakeholders. Payer relationships will include all aspects of MinuteClinic services, including Primary Care, Retail Care, and/or Behavioral Health.

What you will do

• Acts as a top-level specialist in contract negotiations with payers, establishing reimbursement rates, terms, and conditions that align with business objectives and financial goals.

• Creates and maintains strong working relationships with payer representatives and key decision-makers, including addressing concerns or issues, and collaborating to identify opportunities for mutually beneficial results.

• Advises on the development of the organization's payer strategy by analyzing market trends, identifying emerging opportunities, and assessing payer landscape dynamics.

• Evaluates payer performance metrics, such as claims processing, reimbursement accuracy, and contract compliance, and identifies areas for improvement.

• Develops and executes payer agreements by collaborating with legal, finance, and operations to ensure all payer aspects are sufficiently addressed and advanced.

• Interfaces with internal stakeholders to ensure timely and accurate fee schedule implementations and educate stakeholders on terms and conditions of payer arrangement.

• Corrects conflicts, addresses grievances, and negotiates satisfactory resolutions of payer-related issues and disputes.

• Consults on industry trends, regulatory changes, and healthcare policy developments that could impact payer relations and reimbursement models.

• Provides continuous recommendations to senior leadership to guide decision-making and ensure alignment with the organization's strategic goals.

Required Qualifications:

• Minimum 7 years work experience managing payer and/or provider contracting for fee for service and/or value-based contracting.

• Experience working with multiple different payer and/or provider systems, including established network of payer contacts

• Familiar with contract analytics, implementation, and ongoing contract management

• High level understanding of claims, credentialling, and revenue cycle processes

• Proficient in Microsoft Office Products, specifically Excel

• Ability to think independently in a fast-paced environment where priorities change quickly.

• Adept at problem solving within a large matrix organization and skilled in leveraging interpersonal relationships and teamwork to solve complex problems

• Adept at execution and delivery (planning, delivering, and supporting) skills.

Education

• Bachelor's degree preferred

Pay Range

The typical pay range for this role is:

$67,900.00 - $182,549.40

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.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit Benefits | CVS Health (https://jobs.cvshealth.com/us/en/benefits)

We anticipate the application window for this opening will close on: 12/31/2024

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

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.