We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.
- Position Summary
- + Reviews, analyzes, negotiates and executes Medicaid contracts.
+ Leads reimbursement dispute resolution and settlement negotiations with provider groups for the Medicaid line of business. + Completes all activities related to standard contract intake and implementation. + Manages contract performance in support of network quality, availability, and financial goals and strategies. + Recruits providers as needed to ensure attainment of network expansion and adequacy targets. + Collaborates cross-functionally to contribute to provider compensation and pricing development activities and recommendations, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities. Responsible for identifying and making recommendations to manage cost issues and supporting cost saving initiatives and/or settlement activities. + Provides network development, maintenance, and refinement activities and strategies as applicable. + Provides contract expertise and support to other internal business partners/units related to contract setup accuracy, language interpretation, claims payment and/or other matters requiring network contracting expertise. + Leads and/or participates in special projects.
- Required Qualifications
- + 3-5 years experience with provider contract negotiations or provider relations experience + Proven working knowledge of the Medicaid service line, preferably the state of Kentucky program. +
- Must reside in the state of Kentucky
- Preferred Qualifications
- + Ideal candidate may also have Medicaid provider relations or claims payment expertise.
+ Proven and proficient managed care network negotiating skills. + Strong communication, critical thinking, problem resolution and interpersonal skills + Adept at execution and delivery (planning, delivering, and supporting) skills + Adept at business intelligence + Adept at collaboration and teamwork + Adept at growth mindset (agility and developing yourself and others) skills
- Education
- Bachelor's Degree or equivalent relevant work experience
- Anticipated Weekly Hours
- 40 •Time Type•Full time •Pay Range•The typical pay range for this role is: $54,300.
00 - $119,340.00 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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments (https://learn.bswift.com/cvshealth-mainland) . We anticipate the application window for this opening will close on: 07/31/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran — committed to diversity in the workplace.
