Network Relations Manager, CVS Health

CVS Health

Location:
United States, Miami

Category:
Health and Beauty

Contract Type:
Employment contract

Salary:

54300.00 - 119340.00 USD / Year

Save Job

Apply Position

Job Description:

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.

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
Supports or assists with operational activities that may include database management and contract coordination
Performs credentialing support activities as needed
Educates Medicaid providers as needed to ensure compliance with contract policies and parameters
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
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

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 in FL - Miami Dade or Broward County
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

What we offer:

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
No-cost 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:
September 24, 2025

Expiration:
November 17, 2025

Employment Type:

Fulltime

View All Jobs In This Company

Job Link Share:

Network Relations Manager