Sobre

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 As a key member of the Network team, this role leverages deep expertise in healthcare provider contracts, provider data, and network operations to support the development and maintenance of a high-performing regional provider network. The network is designed to meet or exceed standards for accessibility, compliance, quality, and financial performance. The position collaborates cross-functionally to support negotiations for new and renewing provider agreements, serving as a subject matter expert on contract templates, documentation requirements, and contract management tools. Responsibilities also include conducting audits to support network expansion and contract maintenance, as well as initiating and supporting remediation efforts to ensure data and operational integrity. What You Will Do Assist with establishing and implementing results-based programs and innovative initiatives for the network operations area, under general supervision. Collaborate internally and cross-functionally to support initial negotiations and re-negotiations of complex health care provider contracts. Utilize recruitment databases and contract management tools to design, build, load, audit, and edit complex contracts, agreements, amendments and fee schedules for physician/medical groups, IPAs, hospitals, and ancillary providers to support provider network maintenance and growth. Conduct research, analysis, and audits to proactively identify or promptly respond to contract-related complications and propose solutions to protect data, maintain contract integrity, enhance contract performance, and resolve provider concerns. Provide team with technical and other expertise for questions related to contract management system and the information contained therein. Coordinate and support contracting-related activities including pre- and post-signature contract reviews, accurate financial analysis, contract approvals, contract processing, and post-execution contract management. Apply knowledge of network operations to offer constructive feedback or suggest innovative operational approaches that enhance organizational performance, efficiency, and growth. Conducts comprehensive audits of provider applications and supporting documentation to ensure compliance with internal policies, regulatory standards, and contractual requirements. Identifies trends and root causes of recurring data quality issues through audit findings, and partners with relevant teams to implement corrective actions and process improvements. Maintains audit documentation and reporting in accordance with organizational standards, ensuring transparency, traceability, and readiness for internal or external review. Supports audit readiness efforts by developing and maintaining audit tools, checklists, and templates that promote consistency and accuracy across the Network Audit team. Collaborates with cross-functional teams (e.g., Credentialing, Contracting, Provider Relations) to resolve discrepancies and ensure timely remediation of audit findings. Utilizes data analytics tools (e.g., QuickBase, Excel, SharePoint) to track audit outcomes, monitor KPIs, and generate reports that inform leadership decisions. The ideal candidate will possess strong analytical and problem-solving skills, with the ability to work independently while maintaining clear and professional communication across teams. This role requires a high level of attention to detail, initiative, and the ability to navigate complex provider data and documentation. Required Qualifications 3-5 years of experience working in managed healthcare contracting, network management, or supporting roles. QuickBase, Excel and SharePoint experience. Experience with multi-tasking and prioritizing duties. Preferred Qualifications 3-5 years of experience with collaboration and cross-functional teamwork. 1-2 years of experience maximizing data accuracy. Working knowledge of medical claims and coding. Education Bachelor’s degree or equivalent experience (HS diploma + 4 years relevant experience) Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $46,988.00 - $112,200.00 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. 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 We anticipate the application window for this opening will close on: 11/18/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.