Manager, Provider Relations – National Health Systems

Job not on LinkedIn

🔥 13 hours ago

🏈 Alabama, Arizona, +41 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🦬 Montana – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🌶️ New Mexico – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ☕ Washington – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote

💵 $54.3k - $159.1k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 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

• Manage relationships with assigned strategic providers • Serve as a primary point of contact for provider operational issues, inquiries, and escalations • Investigate and resolve complex provider concerns involving claims, rework, appeals, provider data, credentialing, and reimbursement • Partner with Claims, Appeals, Operations, Provider Data, Credentialing, Medical Management, and Contracting teams • Analyze provider service trends, operational performance, and issue root causes • Support provider performance initiatives related to quality, access, operational efficiency, and member experience • Educate providers on health plan programs, administrative processes, self-service tools, and operational requirements • Support value-based care initiatives through provider engagement, education, and operational support • Assist with network adequacy activities, provider recruitment, and regulatory initiatives • Research and respond to provider complaints, disputes, executive escalations, and regulatory inquiries • Monitor provider issues through resolution and communicate status updates • Support implementation of network and operational initiatives affecting providers • Prepare provider-facing materials, business summaries, issue analyses, and leadership updates • Ensure compliance with contractual requirements, regulatory standards, and company policies • Support special projects and cross-functional initiatives

🎯 Requirements

• 4+ years of experience in healthcare operations, provider relations, network management, managed care, claims, provider services, or related healthcare experience • Demonstrated experience working directly with physicians, hospitals, ancillary providers, or healthcare organizations • Experience researching and resolving complex operational or provider-related issues • Strong analytical and problem-solving skills • Understanding of healthcare operations including claims processing, provider enrollment, credentialing, provider data management, and reimbursement fundamentals • Ability to collaborate effectively across a highly matrixed organization • Strong verbal, written, and presentation communication skills • Ability to manage multiple priorities simultaneously and deliver results in a fast-paced environment • Proficiency with Microsoft Excel, PowerPoint, and data analysis tools • Bachelor's degree or equivalent combination of education and relevant professional experience • Experience supporting complex and strategic provider organizations • Knowledge of Commercial, Medicare, Medicaid, and ACA products • Experience resolving provider claims and reimbursement issues • Experience handling provider disputes, executive complaints, regulatory inquiries, or escalated operational issues • Familiarity with provider network operations, provider data management, credentialing, and enrollment processes • Knowledge of value-based care programs and provider performance initiatives • Experience with provider reporting, operational analytics, and root cause analysis

🏖️ 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 in addition to base pay