Contract Negotiation Manager (Texas)

CVS Health • Fort Worth, TX

7d

About The Position

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 Manager of Contract Negotiation is responsible for building and sustaining strategic relationships with physician partners, including ancillary providers and multiple groups across various Texas markets, supporting both Commercial and Medicare lines of business. In addition to managing these key relationships, the Manager develops, reviews, analyzes, and executes provider contracts while ensuring accurate implementation of negotiated agreements. They continuously monitor contract performance to ensure alignment with organizational goals related to accessibility, compliance, quality, financial outcomes, and cost efficiency.

Requirements

• 5–7 years of relevant experience with demonstrated, proficient managed care network negotiation skills.
• 5–7 years of experience with strong working knowledge of competitor strategies, complex contracting methodologies, financial and reimbursement arrangements, and applicable regulatory requirements.
• Strong communication, critical thinking, problem solving, and interpersonal skills with the ability to influence, collaborate, and resolve issues effectively.
• 3–5 years of experience and solid understanding of Commercial HMO, PPO, and Medicare products.
• In depth knowledge of the Texas region, including comprehensive familiarity with the Texas Behavioral Health provider landscape.
• Proficiency in Microsoft Office Suite, including Excel, Word, and related applications.
• Candidates must reside in the state of Texas.

Nice To Haves

• Proficiency with EPDB (Enterprise Provider Database) or experience using Ramba.

Responsibilities

• Negotiates, executes, reviews, and analyzes contracts and/or handles dispute resolution and settlement negotiations with solo and group Behavioral Health providers for all lines of business (Medicare, commercial etc.).
• Manages contract performance in support of network quality, availability, and financial goals and strategies for all lines of business (Medicare, commercial etc.).
• Recruits Behavioral Health providers as needed to ensure attainment of network expansion and adequacy targets for all lines of business (Medicare, commercial etc.).
• 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 Behavioral Health 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.

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager