Project Manager, Provider Network Contract Validation

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.

Position Summary
 

Dynamic position within the new Network Contract Validation team, responsible for ensuring accurate payment of provider contracts through Health Rules Payor (HRP) a claims processing platform. As part of the Network Contract Validation team, you will be responsible for reviewing, auditing, and coordinating the correction (if necessary) of HRP contract setup against contract intent and evaluate the pricing performance of claims. Accurate provider pricing configuration is critical to claims adjudication, and ultimately, having satisfied consumers and providers. By working closely with other areas of the company such as Network, Provider Data Services, Next Gen Provider Contract/Pricing team, Business Intent Review (BIR), HRP Provider Demographics, HRP Claims, HRP Product, legal/compliance, medical policy, and/or segment leaders this position will be responsible for ensuring the correct decisions were made when configuring contract and pricing features in HRP prior to contract implementation.  Additionally, this role may participate with workgroups for process improvement.
Required Qualifications

- Experience with SCM (Strategic Contract Manager) and/or EPDB (Enterprise Provider Database), and/or HRP (Health Rules Payor) is required

- Project Management

- Basic understanding of Provider Contracting is required
- Experience with EXCEL and working with large data files is critical.
Preferred Qualifications

- Claims processing experience is desired.

- Experience with Health Rules Payor is desired.

- Proven track record in meeting project milestones and negotiating for resources.

- Proven communication skills both written and verbal.

- Proven ability to affect change/interpersonal skills.

- Knowledge of Aetna's Commercial and Medicare products

- Strong organization skills & time management

- Able to independently resolve problems.

- Ability to handle multiple assignments accurately and efficiently

- Able to interpret data, translate it into meaningful information and draw conclusions
Education

-Bachelor's degree preferred/specialized training/relevant professional qualification

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

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. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• 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.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

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