Hybrid Network Relations Manager

at CVS Health

• Job title: Network Relations Manager
• Job type: Full Time
• Experience level: Mid level, Senior
• Salary: $60,300 - $132,600 per year
• Degree requirement: Bachelor's Degree
• Location requirements: Hybrid, Swissvale, United States

About the role

• Manager maintaining relationships with high profile Medicaid providers and groups at CVS Health. Addressing complex Medicaid issues and ensuring compliance with practices and needs.

Responsibilities

• Acts as the primary resource for assigned, high profile providers and/or groups to establish, oversee, and maintain positive relationships.
• 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.
• Monitors service capabilities and collaborates cross-functionally to ensure that the needs of constituents are met.
• 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 agendas, validates materials, and facilitates external provider meetings.

Requirements

• A minimum of 5 years' work experience in healthcare.
• Minimum of 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 the designated territory as assigned.
• Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claim Lifecycle, Provider Appeals & Disputes, and Network Performance Standards (preferred).
• Experience in Medical Terminology, CPT, ICD-10 codes, etc. (preferred).

Benefits

• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.