Network Relations Manager, CVS Health

CVS Health

Location:
United States, Annapolis

Category:
-

Contract Type:
Not provided

Salary:

66330.00 - 145860.00 USD / Year

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Job Description:

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Job Responsibility:

Acts as the primary resource for assigned, high profile providers and/or groups to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding Medicaid policies and procedures, plan design, contract language, service, claims or compensation issues, and provider education needs
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 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 Medicaid providers as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, policies, 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
Collaborate cross-functionally with the implementation of large provider systems, to manage cost drivers and execute specific cost initiatives to support business objectives and to identify trends and enlist assistance in problem resolution
May provide guidance and training to less experienced team members
Collaborate with Provider Enablement & Strategy on Provider-facing communications, desktops, workflows, external trainings, reporting needs, and HUB support
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
Must reside within the Baltimore City and Anne Arundel Counties

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, etc.

What we offer:

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
No-cost 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
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
August 01, 2025

Expiration:
September 01, 2025

Employment Type:

Fulltime

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Network Relations Manager