Job Description

Employment Type: Full-time Anticipated Weekly Hours: 40 Time Type: Full-time Pay Range: $60,300.00 - $159,120.00 annually

Position Overview

This role serves as the primary resource for an assigned profile of large provider groups/health systems. The position is responsible for establishing, overseeing, and maintaining provider risk management and positive relationships, while also supporting high-value initiative activities. The goal is to drive the implementation of internal and external solutions to achieve provider satisfaction, cost targets, network growth, and efficiency targets.

Responsibilities

• Optimize interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships.
• Manage provider servicing matters and collaborate cross-functionally to ensure constituent needs are met by driving resolutions for escalated issues related to claims payment, policies, accuracy of provider demographic information, and contract interpretation.
• Educate providers to ensure compliance with contract parameters, plan design, compensation process, technology, policies, and procedures.
• Manage the development of agendas, validate materials, and facilitate external provider meetings to ensure service levels are meeting expectations.
• Collaborate cross-functionally to manage cost drivers and execute specific cost initiatives to support business objectives and identify trends for problem resolution.
• Perform other duties as assigned.

Requirements

• Required Qualifications:
  • Strong verbal and written communication, interpersonal, conflict resolution, and critical thinking skills with a proven ability to influence and collaborate with providers and partners at all levels.
  • 3 to 5 years of provider relations experience, including non-standard relationships with providers and exposure to benefit plan design and/or contract interpretation.
  • Working knowledge of business segment specific CPT and HCPC codes, products, and terminology.
  • Proven advanced problem-solving skills, conflict management abilities, and the capacity to work independently as a self-starter.
  • Prior Medicare and Commercial insurance experience.
  • Willingness to travel 10-15% to providers.
  • Ability to work remotely within the Virginia, Maryland, or District of Columbia area.
• Preferred Qualifications:
  • Ability to educate on an outcome or position, even if unfavorable.
  • Ability to evaluate data and identify action plans or solutions based on the data.

Education

• Bachelor's degree or equivalent professional work experience.

Company Information

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels, and more than 300,000 purpose-driven colleagues – caring for people where, when, and how they choose in a way that is uniquely more connected, more convenient, and more compassionate. We do it all with heart, each and every day.

Our people fuel our future. Our teams reflect the customers, patients, members, and communities we serve, and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people: We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional, and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plans.

Note: This position is eligible for a CVS Health bonus, commission, or short-term incentive program in addition to the base pay range listed above.