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Network Relations Manager

https://www.cvshealth.com/ Logo

CVS Health

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Location:
United States , Massachusetts ▼

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Category:
Health and Beauty

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Contract Type:
Employment contract

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Salary:

66330.00 - 145860.00 USD / Year
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Job Description:

At CVS Health, we are focused on transforming health care by building a world of health around every consumer through innovative solutions. The role involves managing relationships with providers to ensure operational success and cost-effectiveness, with responsibilities including recruitment, contracting, and compliance oversight. The position demands interaction with key stakeholders and an ability to address complex challenges.

Job Responsibility:

  • Acts as the primary resource for assigned profile of larger and more complex providers to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding policies and procedures, plan design, contract language, service, claims or compensation issues, and provider education needs
  • Drives the implementation of internal and external solutions to achieve provider satisfaction, cost targets, network growth, and efficiency targets
  • Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships
  • Monitors service capabilities and collaborates cross-functionally to ensure that the needs of constituents are met and that escalated issues related but not limited to, claims payment, contract interpretation or parameters, and accuracy of provider contract or demographic information are resolved
  • Supports or assists with operational activities that may include, but are not limited to, database management, and contract coordination
  • Performs credentialing support activities as needed
  • Educates providers as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, policies, and procedures
  • Meets with key providers periodically to ensure service levels are meeting expectations
  • Manages the development of agenda, validates materials, and facilitates external provider meetings
  • Conduct standard provider recruitment, contracting, or recontracting activities and assist with more complex contracting and discussions as needed by business segment
  • May provide guidance and training to less experienced team members

Requirements:

  • 4+ years' experience in business segment specific environment servicing or managing non-standard relationships with providers with exposure to benefit plan design and/or contract interpretation
  • 3-5 years' experience with business segment specific policy, benefits, plan design and language
  • Working knowledge of business segment specific codes, products, and terminology
  • 1-2 years of Medicare and Commercial background
What we offer:
  • Affordable medical plan options
  • 401(k) plan (including matching company contributions)
  • Employee stock purchase plan
  • No-cost wellness programs including wellness screenings, tobacco cessation, and weight management programs
  • Confidential counseling and financial coaching
  • Paid time off
  • Flexible work schedules
  • Family leave
  • Dependent care resources
  • Tuition assistance
  • Retiree medical access

Additional Information:

Job Posted:
May 03, 2025

Employment Type:
Fulltime
Work Type:
Remote work
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