Job Description The Senior Manager, Payer Relations, is responsible for leading all payer strategy, including market payer assessment, contract development, negotiation, relationship management, and overseeing all aspects of payer operations processes.
In this role you will collaboration with the program business and clinical leadership, define the contracting strategy and priorities. You will be responsible for the negotiation and execution the contracts, and lead the on-going relationship management with payers. You will oversee the operations management of established contracts and supervise the Payer Operations Senior Consultant and Consultant.
Your key job responsibilities will be:
- Defining the payer strategy including priority payer, reimbursement targets, etc.
- Identifying new payer opportunities, including medical health plans, vision benefit managers, ACOs, employers, etc. to increase coverage of patient services.
- Assessment of marketplace to identify gaps in coverage.
- Engaging potential payers with service offering presentation, in conjunction with program business leadership as needed.
- Leading contracting negotiations, including analysis of reimbursement, assessment of payer requirements, and contract language review and execution.
- Partner on with Finance to conduct contract performance reviews
- Lead all payer operations activities, including identifying and implementing efficiencies across the department including automation opportunities and workflow improvement opportunities to reduce manual efforts.
Required Qualifications - 10+ years of payer contracting experience for health plan, medical group, physician or other provider type required.
- Experience with Audiology and/or Optometry service contracting a strong plus.
- Experience negotiating various reimbursement methodologies including fee-for service, case rates and capitation.
- Ability to travel up to 20%.
Preferred Qualifications - Solid contract management and database system related experience.
- Strong payer operations experience and ability to lead a team of contract operations consultants to meet the responsibilities of the department.
- Project planning and management experience in leading cross-functional project teams to achieve on-time successful results.
- Excellent written and verbal skills including formal and effective presentation and ability to impact and influence peers, leaders and key partners.
- Ability to understand data, analyze reporting and make sound recommendations and business decisions.
- Critical thinking and problem identification and solving skills along with the ability to manage and execute under pressure with opposing priorities.
- Strong credibility, positive attitude and solid relationship management skills in interactions with internal and external customers.
- Proficient with Microsoft Office programs: Word, Excel, Outlook and PowerPoint.
- Analyze and report on metrics, identifying trends and opportunities.
- Maintain a professional, collaborative and positive work environment that promotes high performance.
Education Bachelor's degree or 10+ years of relevant work experience Business Overview
CVS Health, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units – MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers.
CVS Health is an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, ethnicity, ancestry, color, religion, sex/gender (including pregnancy), national origin, sexual orientation, gender identity or expression, physical or mental disability, medical condition, age, veteran status, military status, marital status, genetic information, citizenship status, unemployment status, political affiliation, or on any other basis or characteristic prohibited by applicable federal, state or local law. CVS Health will consider qualified job candidates with criminal histories in a manner consistent with federal, state and local laws. CVS Health will not discharge or in any other manner discriminate against any Colleague or applicant for employment because such Colleague or applicant has inquired about, discussed, or disclosed the compensation of the Colleague or applicant or another Colleague or applicant. Furthermore, we comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW
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CVS Health does not require nor expect that applicants disclose their compensation history during the application, interview, and hiring process.
For inquiries related to the application process or technical issues please contact the Kenexa Helpdesk at 1-855-338-5609. For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352. Please note that we only accept resumes via our corporate website: https://jobs.cvshealth.com/