Manager, Payer Relations

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Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Position Summary

Supporting contracting efforts under the Retail Health division of CVS Health, the Manager, Payer Relations manages and optimizes relationships with payers which serve as the primary revenue source and access channel for MinuteClinic patients. This role may independently manage regional payers and/or support Contract Directors managing large national and regional payers. Additionally, this role will be responsible for leading organizational efforts to improve the accuracy and efficiency of payer relationship management and payer contract compliance.

The Retail Health Contracting and Value team strategically negotiates contracts, evaluates payer performance, resolves issues, and disputes, and collaborates with internal and external stakeholders. Payer relationships will include all aspects of MinuteClinic services, including Primary Care, Retail Care, and/or Behavioral Health. Additionally, the team is responsible for select vendor contracts that support the administration of MinuteClinic services.

Position may sit anywhere in the country but East Coast and/or near CVS Hub location preferred.

What you will do

• Supports contract negotiations with payers and vendors, establishing rates, terms, and conditions that align with business objectives and financial goals.

• Maintains strong working relationships with external partners and key decision-makers, including addressing concerns or issues, and collaborating to identify opportunities for mutually beneficial results.

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

• Collaborates with internal stakeholders to ensure timely and accurate contract implementations and ongoing expert on terms and conditions of payer arrangement.

• Coordinates and negotiates satisfactory resolutions of payer-related issues and disputes.

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

• Leverages analytical skills for special products that require root cause analysis and executive summarization to facilitate decision making.

• Manages department-wide efforts to improve the accuracy and efficiency of payer relationship management processes.

Required Qualifications:

• Minimum 5 years work experience with health care contracting.

• Experience working with payer and/or provider systems.

• In-depth understanding of health care processes (e.g., claims and revenue cycle processes).

• Experience with contract governance and performance management.

• Ability to produce executive deliverables (emails, PowerPoint, presentations) that synthesize complex issues to facilitate understanding and decision making.

• Proficient in Microsoft Office Products, specifically PowerPoint and 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.

Education

• Bachelor's degree preferred.

Pay Range

The typical pay range for this role is

$54,300.00 - $145,860.00

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.

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 (~~~)

We anticipate the application window for this opening will close on: 01/20/2025

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.