Senior Manager, Provider Contracting; TX​/OK

Overview

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose‑driven colleagues — caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate.

And we do it all with heart, each and every day.

The Senior Manager leads the strategy, negotiation, and execution of contracts with providers and delivery systems for Aetna’s managed care networks. This role is responsible for driving value‑based care initiatives, expanding and optimizing the provider network, and ensuring all activities align with company standards and business objectives.

• Strategic Leadership:
  Develops and implements strategies to enhance provider network participation and achieve organizational goals.
• Contract Negotiation & Execution:
  Leads complex negotiations and executes contracts with major provider groups, systems, and facilities, ensuring significant financial and strategic impact.
• Value‑Based Care Engagement:
  Drives provider engagement in value‑based care (VBC) initiatives and supports the implementation of value‑based contract relationships.
• Network Expansion:
  Recruits providers to meet network growth and adequacy targets, ensuring robust participation and compliance with state and product requirements.
• Cost Management:
  Accountable for cost arrangements within defined groups, identifies and manages cost issues, and collaborates cross‑functionally to implement cost‑saving initiatives.
• Cross‑Functional
  
  Collaboration:
  
  Partners with internal teams on provider compensation, pricing, contract submissions, and reimbursement modeling, reviews and analyzes reports to inform negotiation strategies, and manages high‑level projects with interdepartmental resources.
• Relationship & Stakeholder Management:
  Builds and maintains strong relationships with providers, delivery systems, high‑visibility stakeholders, and promotes collaboration with internal partners.
• Issue & Dispute Resolution:
  Ensures timely resolution of escalated issues related to claims, contract interpretation, and provider information accuracy.
• Continuous Improvement:
  Proactively evaluates, designs, and implements innovative network strategies to achieve contracting targets and optimize medical cost management. Regularly assesses the effectiveness of tactical plans and enhances collaboration between providers and internal business partners to drive operational excellence and meet evolving organizational needs.

• 3 years of related experience and comprehensive level of negotiation skills with individuals, PHOs, ancillary providers, hospitals, large or complex provider systems.
• 5 years of overall Provider Negotiation experience.
• Strong knowledge of provider financial issues, contracting options, and regulatory requirements.
• Excellent communication, critical thinking, problem‑solving, and interpersonal skills.
• Ability to manage multiple negotiations and projects simultaneously, meeting deadlines and maintaining strong relationships.
• Proficiency in Microsoft Office Suite.
• Highly effective in a remote work environment.

• Experience with Commercial and Medicare products.
• Familiarity with Aetna internal systems and processes.
• Preferred location:
  North Texas, Oklahoma, or internal candidates from other markets.

• Bachelor’s degree or equivalent combination of education and experience.

The typical pay range for this role is: $75,400.00 – $. 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…