Network Relations Manager, CVS Health

CVS Health

Location:
United States, Trenton

Category:
Health and Beauty

Contract Type:
Employment contract

Salary:

72360.00 - 159120.00 USD / Year

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Job Description:

The candidate will act as the primary resource for assigned providers by managing relationships, operational activities, and compliance with Medicaid policies and procedures. The role includes collaboration across teams, resolving escalated issues, conducting training, and ensuring provider needs are met.

Job Responsibility:

Acts as the primary resource for assigned, high profile providers and/or groups to establish, oversee, and maintain positive relationships
Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships
Monitors service capabilities and collaborate cross-functionally to ensure that the needs of constituents are met and that escalated issues are resolved
Supports or assists with operational activities including database management and contract coordination
Performs credentialing support activities as needed
Educates Medicaid providers to ensure compliance with policies, parameters, and procedures
Meets with key Providers at regular intervals to ensure service levels meet expectations
Manages the development of agenda, validates materials, and facilitates external provider meetings
Collaborates cross-functionally with the implementation of large provider systems to manage cost drivers and execute specific cost initiatives
Provides guidance and training to less experienced team members
Collaborates with Provider Enablement & Strategy on Provider-facing communications and external trainings
Other duties as assigned.

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

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

What we offer:

Affordable medical plan options
A 401(k) plan including matching company contributions
Employee stock purchase plan
No-cost programs including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
Flexible work schedules
Family leave
Dependent care resources
Tuition assistance
Retiree medical access
Paid time off

Additional Information:

Job Posted:
August 27, 2025

Expiration:
October 20, 2025

Employment Type:

Fulltime

Work Type:

On-site work

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Network Relations Manager