Network Relations Manager

2 months ago


Mountain Home, Arkansas, United States CVS Health Full time
About the Role

CVS Health is seeking a highly skilled Network Relations Manager to join our team. As a key member of our organization, you will play a critical role in establishing and maintaining positive relationships with healthcare providers.

Key Responsibilities
  • Research and resolve complex contract-related issues, ensuring seamless provider relationships.
  • Collaborate with Claims SME to resolve payment and compensation issues.
  • Conduct on-site, virtual, and telephonic visits with providers to address their needs and concerns.
  • Facilitate Joint Operating Committee (JOC) meetings and webinars to educate providers on our services.
  • Develop and manage provider-facing communications, including newsletters, website updates, and email blasts.
  • Work closely with Quality Management and VBS teams to enhance quality metrics and build strong relationships with providers.
  • Monitor grievances and implement corrective actions in accordance with NCQA standards.
  • Ensure provider performance meets contract and regulatory requirements.
  • Attend Plan committee meetings as needed and participate in recredentialing efforts.
  • Manage IPA provider rosters and submit updates to MPOS.
  • Document visits and encounters in CRM systems.
  • Travel within the market to meet with providers.
Requirements
  • 5-7 years of experience in provider relations or a related field.
  • Strong verbal and written communication, interpersonal, problem resolution, and critical thinking skills.
  • Working knowledge of business segment-specific codes, products, and terminology.
  • Candidate must reside in Pennsylvania.
  • Travel required.
Preferred Qualifications
  • Experience in Medicaid managed care business segment environment servicing providers with exposure to benefits and/or contract interpretation.
Education

Bachelor's Degree or equivalent combination of education and experience.

Pay Range

The typical pay range for this role is $60,000 - $132,600.00 per year. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors, including experience, education, geography, and other relevant factors.



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