Manager, Network Relations at CVS Health

Oklahoma City, Oklahoma, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Health InsuranceIndustries

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 defined territory up to 50-80% of the time
Must reside in Oklahoma
Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills
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
Bachelor's degree preferred or a combination of professional work experience and education

Responsibilities

Acts as the primary resource for assigned, high profile providers and/or groups 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 collaborate 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, 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
Collaborate with Provider Enablement & Strategy on Provider-facing communications, desktops, workflows, external trainings, reporting needs, and HUB support
Other duties as assigned

Skills

Key technologies and capabilities for this role

Medicaid PoliciesProvider RelationsContract ManagementClaims ResolutionProvider EducationCredentialingDatabase ManagementCross-Functional Collaboration

Questions & Answers

Common questions about this position

What are the required qualifications for this role?

A minimum of 5 years' work experience in healthcare is required, along with at least 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, and the ability to travel within the defined territory up to 50-80% of the time.

Is travel required for this position?

Yes, travel within the defined territory is required up to 50-80% of the time.

Where must candidates reside for this role?

Candidates must reside in Oklahoma.

What salary or compensation is offered for this position?

This information is not specified in the job description.

What skills make a strong candidate for this Manager, Network Relations role?

Strong verbal and written communication, interpersonal, problem resolution, and critical thinking skills are essential, along with preferred knowledge in the field and experience providing guidance to less experienced team members.

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters

1963Year Founded

DEBTCompany Stage

Healthcare, Consumer GoodsIndustries

10,001+Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.

The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.

The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.

The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.

CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.

Increased consumer interest in wellness boosts demand for CVS's health-related products.

The trend towards value-based care aligns with CVS's integrated healthcare approach.

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