Network Relations Manager (Oklahoma)

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.

Responsibilities

• Acts as the primary resource for assigned, high‑profile providers and/or groups (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 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 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.
• Collaborates cross‑functionally with the implementation of large provider systems to manage cost drivers and execute specific cost initiatives to support business objectives, identify trends, and enlist 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.
• Performs other duties as assigned.

Required Qualifications

• Minimum of 5 years' work experience in healthcare.
• Minimum of 3 years of experience in the healthcare industry, including provider relations, managed care, health plan operations, healthcare delivery, or a related area, 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% of the time.
• Must reside in Oklahoma.

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.
• Proficient in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook