Provider Network Contracting Metro NY

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**This person must sit within a commutable distance to the NYC office**

Position Summary

Aetna is seeking a Manager Contract Negotiator to support the Metro New York market. This role is responsible for developing negotiating implementing and maintaining provider contracts with physicians hospitals ancillary providers and health systems in support of Aetnas network strategy affordability goals provider access requirements and member experience objectives.

The Manager Contract Negotiator will lead contract negotiations for assigned providers analyze financial and operational impacts of proposed agreements and collaborate with cross-functional partners to drive network performance. This role serves as a key liaison between providers and internal business partners including Network Strategy Provider Relations Finance Actuarial Legal Clinical Operations and Compliance.

The ideal candidate possesses strong negotiation capabilities healthcare industry knowledge financial acumen and the ability to build productive relationships with provider organizations in one of Aetnas largest and most complex provider markets.

Key Responsibilities

• Negotiate execute renew and maintain provider agreements with hospitals physician groups ancillary providers and other healthcare organizations.

• Develop and implement contracting strategies that support market affordability network adequacy access quality and growth objectives.

• Analyze provider reimbursement proposals financial models utilization trends and contract performance data to support negotiations and business decision-making.

• Manage contract amendments reimbursement updates fee schedule changes and contract renewals.

• Establish and maintain strong relationships with provider executives and key decision makers.

• Collaborate with Provider Relations Network Strategy Finance Actuarial Legal Compliance Clinical and Operations teams to support implementation and administration of provider agreements.

• Identify opportunities for cost savings network optimization and provider performance improvement.

• Support value-based care arrangements and alternative payment models including performance-based reimbursement structures.

• Resolve provider disputes and contract-related issues while maintaining positive provider relationships.

• Ensure compliance with regulatory requirements corporate policies and contracting standards.

• Support provider recruitment network expansion and network adequacy initiatives.

• Prepare negotiation strategies executive summaries business cases and leadership presentations.

• Coach and mentor less experienced network contracting colleagues and support cross-functional project initiatives as needed.

• Work-from-home/hybrid role supporting the Metro New York market.

• Periodic travel within Metro New York required to meet with provider organizations and attend business meetings.

• Must be able to effectively engage with provider leadership internal stakeholders and cross-functional partners in both virtual and in-person environments.

Required Qualifications

• A minimum of 3 years of healthcare provider contracting network management provider relations reimbursement health plan operations healthcare consulting or related experience.

• Strong analytical skills with experience evaluating financial models reimbursement structures utilization patterns and provider performance data.

• Working knowledge of healthcare reimbursement methodologies including fee-for-service value-based care capitation and risk-based arrangements.

• Experience partnering across a highly matrixed organization and influencing stakeholders without direct authority.

• Strong problem-solving decision-making and negotiation skills.

• Excellent verbal written and presentation communication skills.

• Ability to manage multiple priorities simultaneously and deliver results in a fast-paced environment.

• Proficient in Microsoft Excel PowerPoint and other analytical tools.

Preferred Qualifications

• Experience negotiating contracts with hospitals integrated delivery systems academic medical centers or large physician organizations.

• Demonstrated experience negotiating provider contracts reimbursement methodologies or healthcare service agreements.

• Experience supporting provider contracting activities within the Metro New York healthcare market.

• Knowledge of Commercial Medicare Medicaid and ACA products.

• Experience with value-based care programs alternative payment models and risk-based contracting arrangements.

• Knowledge of provider network adequacy standards healthcare regulatory requirements and contracting compliance practices.

• Experience with healthcare claims analysis reimbursement modeling or provider performance reporting.

• Familiarity with Aetna network management systems provider contracting platforms or contract administration tools.

• Proven ability to influence senior provider executives and lead complex negotiations involving multiple stakeholders.

• Experience supporting network strategy affordability initiatives and provider performance improvement efforts.

Education

• Bachelors degree or equivalent combination of education and relevant professional experience.

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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

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