Senior Manager, Provider Relations – Metro NY

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🕒 4 days ago

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

Healthcare Insurance • Retail • Wellness

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Lead provider relationship management and service operations, driving issue resolution, provider satisfaction, and cross-functional coordination for complex provider groups. • Drive provider performance related to quality, cost efficiency, access, and member experience metrics. • Partner closely with Network Management, Medical Management, Value-Based Care, Operations, and Finance to execute provider strategies. • Identify opportunities to improve provider engagement, resolve escalated issues, and strengthen collaboration across the provider network. • Support value-based care initiatives, including education, performance monitoring, and provider adoption of new models. • Analyze provider’s performance data and develop action plans to address gaps or risks. • Serve as a senior point of contact for complex provider concerns or operational challenges. • Work cross functionally with additional teams including claims, appeals, interoperability, and contracting to develop creative solutions and root cause issues. • Ensure compliance with regulatory, contractual, and company requirements.

🎯 Requirements

• 7-10 years of experience in healthcare operations, provider relations, managed care, or network management within a payer or provider organization • Demonstrated experience managing provider relationships, including resolving complex service issues, escalations, and provider concerns • Strong understanding of healthcare operations, including: Claims processing and issue resolution, provider service models and workflows • Experience handling high-level escalations, including executive complaints, regulatory inquiries, and provider disputes • Strong analytical and problem-solving skills with the ability to interpret complex data and resolve issues • Ability to travel within Metro NY market as needed to the NYC office or providers offices.

🏖️ Benefits

• medical coverage • dental coverage • vision coverage • paid time off • retirement savings options • wellness programs