Manager, Provider Relations

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🔥 0 minutes ago

🌪️ Oklahoma – Remote

🌪️ Oklahoma – Remote

💵 $54.3k - $119.3k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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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 an internal team responding to inquiries about Medicaid policies and procedures, plan design, contract language, service, claims, compensation issues, and provider education needs • Monitor service capabilities and collaborate cross-functionally to meet constituent needs • Resolve escalated issues involving claims payment, contract interpretation or parameters, and provider contract or demographic information accuracy • Support operational activities including database management and contract coordination • Perform Tin Mapping/Certification and credentialing support activities • Collaborate on implementation of large provider systems, manage cost drivers, execute cost initiatives, identify trends, and enlist assistance in problem resolution • Provide guidance and training to less experienced team members • Collaborate with Provider Enablement & Strategy on provider-facing communications, desktops, workflows, external trainings, reporting needs, and HUB support • Ensure all turnaround times are met according to the state contractual agreement with Aetna Better Health of Oklahoma • Perform other duties as assigned

🎯 Requirements

• 5+ years' work experience in a leadership role • Experience working in a Medicaid plan • Knowledge of QNXT, Quickbase, and WFM (Workflow Manager tool) • Strong knowledge of mapping and certification of providers • Must reside in Oklahoma • Knowledge of Medicaid regulatory standards for network access, credentialing, claim lifecycle, provider appeals and disputes, and network performance standards • Experience in medical terminology, CPT, ICD-10 codes, etc. • Bachelor's degree or equivalent experience • Strong verbal and written communication, interpersonal, problem resolution, and critical thinking skills

🏖️ Benefits

• Medical, dental, and 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