Behavioral Health Network Relations Manager

Job not on LinkedIn

🔥 3 minutes ago

⚜️ Louisiana – Remote

⚜️ Louisiana – Remote

💵 $54.3k - $119.3k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💰 Account Manager

👻 Ghost score 0%

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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

• Act as the primary resource for assigned, high-profile Behavioral Health providers and/or groups • Establish, oversee, and maintain positive provider relationships • Respond to complex issues related to Medicaid policies and procedures, plan design, contract language, service, claims, compensation, and provider education • Optimize interactions with assigned providers and internal business partners • Monitor service capabilities and collaborate cross-functionally to resolve escalated claims, contract, and provider information issues • Support operational activities including database management and contract coordination • Perform credentialing support activities as needed • Educate Medicaid providers on contract policies, plan design, compensation processes, technology, policies, and procedures • Meet with key providers regularly to ensure service levels meet expectations • Develop agendas, validate materials, and facilitate external provider meetings • Collaborate on implementation of large provider systems, cost drivers, cost initiatives, trend identification, and problem resolution • Provide guidance and training to less experienced team members • Collaborate with Provider Enablement & Strategy on provider-facing communications, desktops, workflows, external training, reporting needs, and HUB support • Perform other duties as assigned

🎯 Requirements

• Minimum of 5 years' work experience in healthcare • Minimum of 3 years' experience in a Medicaid Managed Care business segment environment servicing providers, with exposure to benefits and/or contract interpretation • Minimum of 2 years’ experience working with providers and contracts in the behavioral health sector • Working knowledge of business segment specific codes, products, and terminology • Proficiency in Microsoft Office Suite, including Excel, Word, and PowerPoint • Travel within the defined territory up to 50-80% of the time • Candidates must reside in the state of Louisiana and within one of the following parishes: St. Landry, Evangeline, Acadia, Lafayette, St. Martin, Iberia, Vermillion, Beauregard, Allen, Calcasieu, Jefferson Davis, Cameron, Avoyelles, Rapides, Vernon, Grant, Winn, LaSalle, Catahoula, Concordia • 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.

🏖️ Benefits

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