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CVS Health · 1 day ago

Manager, Network Relations (Philadelphia & Delaware County)

Harrisburg, PA

Full-time

Onsite

Mid, Senior Level

$60K/yr - $133K/yr

5+ years exp

CVS Health is a leading health solutions company dedicated to transforming health care for consumers. The Manager, Network Relations will act as the primary resource for high profile providers, overseeing relationships, resolving complex issues, and ensuring compliance with Medicaid policies. This role involves collaboration with various teams and regular communication with key providers to meet service expectations.

Health CareMedicalPharmaceuticalRetailSales

Responsibilities

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

Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills

Collaborate with Provider Enablement & Strategy on Provider-facing communications, desktops, workflows, external trainings, reporting needs, and HUB support

Other duties as assigned

Qualification

Medicaid Managed CareProvider EducationContract InterpretationHealthcare ExperienceMedical TerminologyProblem ResolutionInterpersonal SkillsCritical Thinking

Required

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 defined territory up to 50% of the time

Must reside in Pennsylvania for PA CHIP contract (Philadelphia and Southeastern PA Region -preferred within 1 hour drive of Philadelphia, PA)

Preferred

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

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.