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Network Relations Manager position at CVS Health responsible for establishing and maintaining positive relationships with healthcare providers, handling complex issues regarding Medicaid policies and procedures, and ensuring service levels meet expectations through regular provider meetings and collaboration with internal teams.
Job Responsibility:
Acts as the primary resource for assigned providers to establish and maintain positive relationships
Optimizes interactions with assigned providers and internal business partners
Monitors service capabilities and collaborate cross-functionally
Supports operational activities including database management and contract coordination
Performs credentialing support activities
Educates Medicaid providers to ensure compliance
Meets with key Providers at regular intervals
Manages development of agenda and facilitates external provider meetings
Collaborate cross-functionally with implementation of large provider systems
May provide guidance and training to less experienced team members
Collaborate with Provider Enablement & Strategy on Provider-facing communications
Requirements:
A minimum of 5 years' work experience in healthcare
Minimum of 3 years' experience in Medicaid Managed Care business segment environment servicing providers with exposure to benefits and/or contract interpretation
Working knowledge of business segment specific codes, products, and terminology
Travel within the defined territory up to 50-80% of the time
Bachelor's degree preferred or a combination of professional work experience and education
Nice to have:
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
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