Manager, Network Relations

About the role

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.

Acts as the primary resource for assigned, high profile providers and/or groups (i.e. local, individual providers, small groups/systems) to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding Medicaid policies and procedures, plan design, contract language, service, claims or compensation issues, and provider education needs. Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships. Monitors service capabilities and collaborate cross-functionally to ensure that the needs of constituents are met and that escalated issues related but not limited to, claims payment, contract interpretation or parameters, and accuracy of provider contract or demographic information are resolved. Supports or assists with operational activities that may include, but are not limited to, database management, and contract coordination. Performs credentialing support activities as needed. Educates Medicaid providers as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, policies, and procedures. Meets with key Providers at regular intervals to ensure service levels meet expectations. Manages the development of agenda, validates materials, and facilitates external provider meetings. Collaborate cross-functionally with the implementation of large provider systems, to manage cost drivers and execute specific cost initiatives to support business objectives and to identify trends and enlist assistance in problem resolution. May provide guidance and training to less experienced team members. Collaborate with Provider Enablement & Strategy on Provider-facing communications, desktops, workflows, external trainings, reporting needs, and HUB support. Other duties as assigned.

Responsibilities

• Serve as primary resource for assigned high-profile providers/groups to establish, oversee, and maintain positive relationships
• Assist with or respond to complex issues regarding Medicaid policies, plan design, contract language, service, claims, compensation, and provider education
• Optimize interactions with providers and internal partners to maintain productive, professional relationships
• Monitor service capabilities and collaborate cross-functionally to meet constituent needs and resolve escalated issues (claims payment, contract interpretation, provider contract/demographic accuracy)
• Support operational activities including database management and contract coordination
• Perform credentialing support activities as needed
• Educate Medicaid providers on contract policies, plan design, compensation processes, technology, policies, and procedures
• Meet with key providers at regular intervals to ensure service levels meet expectations
• Develop agendas, validate materials, and facilitate external provider meetings
• Collaborate cross-functionally on large provider system implementations to manage cost drivers and execute cost initiatives
• Identify trends and enlist assistance in problem resolution
• Provide guidance and training to less experienced team members
• Collaborate with Provider Enablement & Strategy on communications, desktops, workflows, external trainings, reporting, and HUB support

Requirements

• Minimum 5 years' work experience in healthcare
• Minimum 3 years' experience in Medicaid Managed Care business segment environment servicing providers with exposure to benefits and/or contract interpretation
• Working knowledge of business segment specific codes, products, and terminology
• Travel within defined territory up to 50–80% of the time
• Must reside in the Dallas/Fort Worth Metroplex
• Strong verbal and written communication, interpersonal, problem resolution, and critical thinking skills

Preferred Qualifications

• Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claim Lifecycle, Provider Appeals & Disputes, and Network Performance Standards
• Experience in Medical Terminology, CPT, ICD-10 codes, etc.

Education

Bachelor's degree preferred or a combination of professional work experience and education.

Schedule

Full time, 40 hours per week.

Pay

The typical pay range for this role is $60,300.00 – $132,600.00 annually. This range represents the base annual full-time salary for all positions in the job grade. The actual base salary offer will depend on 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.

Benefits

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. Benefits 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.