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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

+ Coordinate annual Business rule review for large groups, ensure there are established business rules for all applicable providers.

+ Coordinate transition to roster automation for all applicable providers

+ Assist with obtaining EMR access for UM purposes with willing hospital partners

+ Create standard monthly JOC agenda topics for hospital & physicians

+ Help with internal talking points for new policies

+ Help create standard PEAT tool/provider score card data to share with providers to defend against provider abrasion (if applicable)

+ Manage the bi-annual proprietary fee schedule process in all markets

+ Respond to defined provider escalation tickets

+ Termination process management.

+ Responsible for identifying and making recommendations to manage cost issues and supporting cost saving initiatives and/or settlement activities.

+ Assists with the design, development, management, and or implementation of strategic network configurations, including integration activities.

+ Optimize interaction with assigned providers and internal business partners to manage relationships and ensure provider needs are met.

+ Coaches more junior colleagues in techniques, processes, and responsibilities.

+ Identifying and making recommendations to manage cost issues and supporting cost saving initiatives and/or settlement activities

Required Qualifications

+ Proficient in Office 365 systems, including Excel and PowerPoint.

+ 5+ years related Provider Network experience, proven and proficient negotiating skills.

+ Strong communication, critical thinking, problem resolution skills.

Preferred Qualifications

+ Aetna System knowledge and proficiency

+ Candidates who reside in Kentucky / Ohio are highly preferred

+ Kentucky/Ohio Provider Network knowledge and experience highly preferred

+ Intermediate knowledge of Microsoft Office, specifically Excel and PowerPoint

+ A ready business acumen and the ability to balance and articulate competing priorities while making decisions

+ Strong and persuasive communication skills, especially written communications, with external stakeholders

+ Strong critical thinking, problem resolution and interpersonal skills

+ Adept at execution and delivery (planning, delivering, and supporting) skills

+ Adept at collaboration and teamwork

+ A growth mindset (agility and developing yourself and others) skills

Education

Bachelor’s Degree or equivalent combination of education and experience

Pay Range

The typical pay range for this role is:

$67,900.00 - $149,328.00

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 position also includes an award target in the company’s equity award program.

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: 10/31/2025

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

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.