Provider Relations Senior Manager, CVS Health

CVS Health

Location:
United States, Springfield

Category:
Health and Beauty

Contract Type:
Employment contract

Salary:

82940.00 - 182549.00 USD / Year

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Job Description:

Provides strategic leadership and oversight for the provider experience staff. Develop long-term relationships with network providers and IL Associations by enhancing interactions between providers and the health plan, ensuring seamless communication, operational efficiency, and overall enhancing the provider experience. Drives the implementation of internal and external solutions to achieve provider satisfaction, cost targets, utilization/performance, network growth, and efficiency targets.

Job Responsibility:

Provides strategic leadership and oversight for the provider experience staff
Develop long-term relationships with network providers and IL Associations
Drives the implementation of internal and external solutions to achieve provider satisfaction, cost targets, utilization/performance, network growth, and efficiency targets
Manages and oversees compliance within our network responsibilities
Provider Engagement & Relationship Management
Process Improvement
Data & Insights Utilization
Cross functional Team Collaboration
Stakeholder Collaboration
Training & Support
Research, review, and prepare responses for all governmental, regulatory and quality assurance provider complaints
Provides support and maintenance assistance for websites, portals, directories, provider manuals, and dashboards
Issue Resolution
Compliance
Strategic Oversight
Team Leadership

Requirements:

MUST RESIDE IN ILLINOIS with ability to travel as needed to provider sites and Aetna office locations as required
Excellent interpersonal skills and the ability to work with others at all levels
Minimum of 5+ years' working experience in Provider Relations or Network Strategy
Minimum 5+ years' experience in Medicaid Managed Care business segment environment with exposure to benefits and/or contract interpretation
Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and/or Network Performance Standards
Progressive leadership experience
Excellent analytical and problem-solving skills
Strong communication and presentation skills
Adept at execution and delivery (planning, delivering and supporting)
Adept at collaboration
Working knowledge of business segment specific codes, products, and terminology
Bachelor's degree preferred/specialized training/relevant professional qualifications

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:
August 28, 2025

Expiration:
September 18, 2025

Employment Type:

Fulltime

Work Type:

On-site work

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Provider Relations Senior Manager

CVS Health

Location:United States, Springfield

Category:Health and Beauty

Contract Type:Employment contract