Provider Network Relationship Manager

Job not on LinkedIn

🔥 13 hours ago

🏈 Ohio – Remote

🏈 Ohio – Remote

💵 $60.3k - $132.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💰 Account Manager

👻 Ghost score 0%

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

• Assess overall network composition and potential provider partners • Identify and service partnerships that advance and differentiate the OhioRISE Network • Execute, service, and potentially negotiate contracts with local market providers • Establish and maintain productive relationships 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, and performance measurement • 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-driver management, data reports, and cost initiatives • Drive provider engagement and recruit providers as needed to achieve network expansion and adequacy targets • Assist with strategic network configuration 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 of 2 years of experience reviewing, analyzing, and auditing healthcare claims and claims data • Experience identifying discrepancies, researching and resolving claim issues, and providing insights to support 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 the state of Ohio • Ability to travel within Ohio as needed • Proficiency with MS Office Suite applications • In-depth knowledge of behavioral health market preferred • Experience building and maintaining relationships with behavioral health providers preferred • In-depth knowledge of Ohio managed care market preferred • Bachelor's degree preferred, or a combination of professional work experience and education

🏖️ Benefits

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