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
Bachelor27s 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.
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 fulltime position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial wellbeing 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 .
We anticipate the application window for this opening will close on: 07/31/2026
