Manager, Network Relations (Oklahoma)

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.

Candidate must reside in Oklahoma.

About the Role

Acts as the primary resource for assigned, high-profile providers and/or groups (e.g., 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 collaborates cross-functionally to ensure 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 database management and contract coordination. Performs credentialing support activities as needed.

Educates Medicaid providers 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 agendas, validates materials, and facilitates external provider meetings.

Collaborates cross-functionally on the implementation of large provider systems to manage cost drivers, execute specific cost initiatives to support business objectives, and identify trends to enlist assistance in problem resolution. Assists with standard provider recruitment, contracting, or re-contracting activities and supports more complex contracting discussions as needed. May provide guidance and training to less experienced team members.

Collaborates with Provider Enablement & Strategy on Provider-facing communications, desktops, workflows, external trainings, reporting needs, and HUB support. Other duties as assigned.

Responsibilities

• Serve as the primary resource for assigned providers, addressing complex issues related to Medicaid policies, plan design, contract language, claims, compensation, and education needs.
• Optimize interactions with providers and internal partners to maintain productive, professional relationships.
• Monitor service capabilities and resolve escalated issues (e.g., claims payment, contract interpretation, provider data accuracy).
• Support operational activities, including database management, contract coordination, and credentialing.
• Educate Medicaid providers on compliance with contract policies, plan design, compensation processes, and procedures.
• Conduct regular meetings with key providers to ensure service expectations are met.
• Develop agendas, validate materials, and facilitate external provider meetings.
• Collaborate on the implementation of large provider systems, manage cost drivers, and execute cost initiatives.
• Assist with provider recruitment, contracting, and re-contracting activities, including complex discussions.
• Provide guidance and training to less experienced team members.
• Collaborate on Provider-facing communications, workflows, trainings, reporting, and HUB support.

Requirements

• A minimum of 5 years of work experience in healthcare.
• Minimum of 3 years’ experience in a 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% of the time.
• Must reside in Oklahoma.
• Strong verbal and written communication, interpersonal, problem-resolution, and critical-thinking skills.

Qualifications

• Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes, and Network Performance Standards (preferred).
• Experience with Medical Terminology, CPT, ICD-10 codes, etc. (preferred).
• Bachelor’s degree preferred or a combination of professional work experience and education.

Pay

The typical pay range for this role is $54,300.00 – $119,340.00 annually. The actual base salary offer will depend on factors such as experience, education, geography, and other relevant considerations. This position is also 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, including:

• 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.

Schedule

• Full-time position.
• Anticipated weekly hours: 40.