Senior Manager, Provider Relations

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🔥 0 minutes ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $75.4k - $166k / year

⏰ Full Time

🟠 Senior

💰 Account Manager

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

Healthcare Insurance • Retail • Wellness

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

• Provides strategic leadership and oversight for network management and provider relations • Develops and implements network strategies, monitors provider performance metrics • Leads dispute resolution processes and collaborates with key stakeholders to drive network growth • Assists in creation of reports, attends, and presents at Plan committee meetings • Conducts shadowing during provider visits on-site, virtual, telephonic • Monitors after-visit provider survey • Collaborates with leadership to maintain and update policies and procedures • Assists Providers by resolving inquiries and educating Providers on new protocols, policies, and procedures • Actively participates in State and regulatory audits • Conference participation, as needed • Leads process improvement initiatives across the Provider Engagement team to increase operational efficiency, provider satisfaction, and compliance • Identifies gaps, streamlines workflows, and implements standardized processes to support PE team objectives • Develops and maintains operational procedures, desktop guides, and best practices for the PE team • Monitors performance metrics and recommends improvements to engagement strategies and team effectiveness • Monitors Texas Health and Human Services Commission (HHSC) updates, requirements, and regulatory changes impacting provider operations • Translates regulatory requirements into actionable guidance for the Provider Engagement team • Develops, updates, and maintains PE desktop procedures, reference materials, and training resources • Ensures provider-facing communications and educational materials align with state directives and organizational standards

🎯 Requirements

• A minimum of 7 years' work experience in healthcare • Must have working knowledge of Medicaid • A minimum of 2 years leadership/management experience leading / managing staff to ensure department goals are met • Must have provider facing experience • Travel within Market as needed • This position must reside in Texas within driving distance of HHSC State buildings.

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • other resources, based on eligibility