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Medicaid Network Relations Manager, Princeton, NJ
1 month ago
We are seeking a skilled Medicaid Network Relations Manager to join our team at CVS Health. As a key member of our organization, you will play a critical role in establishing and maintaining positive relationships with assigned providers and internal business partners.
Key Responsibilities- Act as the primary resource for assigned providers, assisting with complex issues related to policies, procedures, plan design, contract language, and provider education needs.
- Optimize interactions with providers and internal partners to establish and maintain productive, professional relationships.
- Monitor service capabilities and collaborate cross-functionally to ensure constituent needs are met and escalated issues are resolved.
- Support operational activities, including database management, contract coordination, and credentialing support.
- Educate providers on contract policies, plan design, compensation process, technology, policies, and procedures.
- Meet with key providers to ensure service levels meet expectations and facilitate external provider meetings.
- Collaborate on the implementation of large provider systems, managing cost drivers and executing specific cost initiatives to support business objectives.
- Conduct standard provider recruitment, contracting, or re-contracting activities and assist with more complex contracting and discussions as needed.
- Approximately 25% travel within a 50+/- mile radius to provider and hospital locations within New Jersey assigned territory.
- Minimum 3+ years' experience in a business segment environment servicing providers with exposure to benefits and/or contract interpretation.
- Minimum 3+ years' experience with business segment specific policy, benefits, plan design, and language.
- Preferred experience in Medicaid Managed Care.
- Strong verbal and written communication, interpersonal, problem resolution, and critical thinking skills with a passion for constituent support.
- Working knowledge of business segment specific codes, products, and terminology.
- Bachelor's degree preferred/specialized training/relevant professional qualification.
At CVS Health, we offer a comprehensive benefits package, including medical, dental, and vision benefits, a 401(k) retirement savings plan, and an Employee Stock Purchase Plan. We also provide a fully-paid term life insurance plan, short-term and long-term disability benefits, and numerous well-being programs. Eligible employees enjoy Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year.
We are an equal opportunity and affirmative action employer, committed to diversity and inclusion. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
