Network Relations Manager

Job not on LinkedIn

🕒 August 10

🐊 Florida – Remote

🐊 Florida – Remote

💵 $60.3k - $132.6k / year

⏰ Full Time

🟠 Senior

🔴 Lead

💰 Account Manager

👻 Ghost score 1%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

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

• Advance the organization’s Value-Based Contracting (VBC) strategy for the Rest of FL Market • Establish and manage relationships with network providers • Analyze provider performance and quality indicators through regular assessments and audits • Address and resolve escalated provider issues and concerns • Collaborate with network contracting teams to negotiate contractual terms and conditions • Develop tactical and operational plans to expand and enhance the network • Work with business development teams to identify and onboard new providers • Monitor and analyze provider demographics and network adequacy metrics • Recommend improvements to network effectiveness and efficiency • Collaborate with finance, operations, customer service, and other cross-functional teams • Conduct regular provider meetings and performance reviews • Monitor industry trends, regulatory changes, and market dynamics and communicate relevant information to internal stakeholders

🎯 Requirements

• Minimum 7 years of experience in healthcare quality, risk adjustment, or compliance within a Medicare Advantage setting • Minimum 5 years of experience in provider relationship management, network management, or provider services within a healthcare environment • Strong understanding of CMS regulations, HEDIS, STAR ratings, and provider engagement strategies • Demonstrated ability to analyze financial and quality performance data and implement process improvements • Must reside within the Florida market, with a preference for candidates located in the Jacksonville or Orlando areas • Experience with Commercial and Medicare lines of business preferred • Ability to build collaborative relationships with providers and work cross-functionally to resolve complex provider contract issues • Highly organized and able to manage and prioritize multiple negotiations, issues, and tasks to meet deadlines • Bachelor's degree preferred or a combination of professional work experience and education

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program in addition to the base pay range • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being