Network Relations Manager - 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 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 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 and execute specific cost initiatives supporting business objectives, identifying trends, and enlisting assistance in problem resolution.

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 high-profile providers/groups on Medicaid policies, plan design, contract language, claims, and compensation issues.
• Oversee and maintain positive relationships with providers and internal business partners.
• Resolve escalated issues related to claims payment, contract interpretation, and provider information accuracy.
• Support operational activities, including database management and contract coordination.
• Perform credentialing support activities as needed.
• Educate Medicaid providers on compliance with contract policies, plan design, 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 large provider system implementations to manage cost drivers and execute cost initiatives.
• Identify trends and assist in problem resolution.
• Provide guidance and training to less experienced team members.
• Collaborate with Provider Enablement & Strategy on provider-facing communications, workflows, trainings, and reporting.

Requirements

• A minimum of 5 years’ work experience in healthcare.
• Minimum of 3 years’ experience in Medicaid Managed Care, servicing providers with exposure to benefits and/or contract interpretation.
• Working knowledge of business segment-specific codes, products, and terminology.
• Travel within the defined territory up to 50-80% of the time.
• Must reside in Oklahoma.

Qualifications

• Strong verbal and written communication, interpersonal, problem-resolution, and critical-thinking skills.
• Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claim Lifecycle, 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 including 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.

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

Schedule

• Full-time.
• 40 anticipated weekly hours.