Provider Network Relationship Manager

Job not on LinkedIn

🔥 2 minutes ago

🏈 Ohio – Remote

🏈 Ohio – Remote

💵 $60.3k - $132.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💰 Account Manager

👻 Ghost score 0%

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CVS Health Careers

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛒 Retail

📦 Logistics

Healthcare • Retail • Logistics

CVS Health Careers is the recruitment and employer branding arm of CVS Health, showcasing job opportunities across the company's broad operations—pharmacy retail stores, pharmacy services, health care clinics, distribution warehouses, corporate functions and transportation. The careers site emphasizes purpose-driven work focused on improving access, affordability and quality of health care, and highlights a large workforce (300,000+ employees), inclusive culture, benefits, and hiring resources for applicants.

📋 Description

• Assess overall network composition and potential provider partners • Identify and service partnerships advancing and differentiating the OhioRISE Network • Execute, service, and may negotiate contracts with local market providers • Optimize interactions with assigned providers and internal business partners • Partner in developing business strategy and programs supporting operational plans • Resolve escalated issues and projects for assigned provider systems • Monitor performance and adherence to scorecards and payout schedules • Educate internal and external parties on contract policies, plan design, compensation processes, technology, performance measurement, policies, and procedures • Meet periodically with key providers to ensure service levels meet expectations • Develop agendas, validate materials, and facilitate external provider meetings • Collaborate on implementation of large provider systems, cost drivers, data reports, and cost initiatives • Drive provider engagement and recruit providers as needed for network expansion and adequacy targets • Assist with strategic network configurations and integration activities • Serve as a subject matter expert for less experienced team members and internal partners

🎯 Requirements

• 5+ years of experience in Medicaid managed care • Proven track record working with individual providers and complex provider systems or groups • Minimum 2 years of experience reviewing, analyzing, and auditing healthcare claims and claims data • Experience identifying discrepancies, researching and resolving claim issues, and providing insights supporting claims administration • Experience reviewing contracts for compliance with applicable state regulatory requirements • Experience identifying potential compliance issues and ensuring contractual terms align with regulations and standards • Strong communication, critical thinking, problem-resolution, and interpersonal skills • Must reside in Ohio • Ability to travel within Ohio as needed • Proficiency with MS Office Suite applications • Bachelor's degree preferred, or a combination of professional work experience and education • Preferred: in-depth behavioral health market knowledge and experience building and maintaining relationships with behavioral health providers • Preferred: in-depth knowledge of the Ohio managed care market

🏖️ Benefits

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

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