Medicaid Network Provider Relations Manager - Remote Opportunity with CVS Health

Transforming Healthcare through Compassionate Leadership

At CVS Health, we're driven by a singular purpose: to bring our heart to every moment of your health. As a leading healthcare organization, we're committed to delivering enhanced, human-centric health care that's both personal and convenient. Our culture is built around 'Heart At Work Behaviors' that empower every team member to play a vital role in transforming our culture and accelerating innovation.

Job Overview: Medicaid Network Provider Relations Manager

We're seeking an experienced Medicaid Network Provider Relations Manager to join our team on a remote basis. This critical role will oversee our Medicaid Provider Experience programs, fostering positive relationships with our Network Providers and driving high-value initiatives. As a key contact for larger, complex providers, you'll implement internal and external solutions to achieve provider satisfaction, cost targets, network growth, and efficiency targets.

Key Responsibilities

• Partner with external provider engagement representatives and internal provider relations representatives to ensure successful Provider relationships and network performance.
• Deploy the Medicaid Provider Engagement program through local market Provider Representatives.
• Assist in the recruitment of new providers as needed and maintain compliance with all network access requirements.
• Recommend and deploy training programs and educational materials for providers and internal staff.
• Develop Network Action Plans to ensure network compliance with state requirements.
• Facilitate Provider Advisory Group and JOC meetings to implement changes and improve provider clinical measures.
• Monitor executed provider contracts to ensure network access meets state requirements.
• Coordinate provider information with Provider Data Services and other internal departments.
• Provide Best-In-Class service to providers by resolving problems and advising on new protocols, policies, and procedures.
• Participate in weekly Grievance and Appeals meetings, tracking and trending provider grievances.
• Assist in responding to governmental, regulatory, and quality assurance provider complaints.
• Support and maintain websites, portals, directories, manuals, and dashboards.
• Promote and educate providers on cultural competency.

Essential Qualifications

To succeed in this role, you'll need:

• A minimum of 5+ years of experience in Provider Relations, preferably in Medicaid servicing or managing non-standard relationships with providers.
• Excellent interpersonal skills and the ability to work with others at all levels.
• Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes, and Network Performance Standards.
• Excellent analytical and problem-solving skills.
• Strong communication and presentation skills.
• Residency in the applicable state with the ability to travel up to 50% to provider sites and Aetna office locations.
• A Bachelor's degree or an equivalent combination of formal education and experience.

Preferred Qualifications

While not essential, the following qualifications are highly desirable:

• Residency in Baltimore or Anne Arundel County.

What We Offer

At CVS Health, we offer a comprehensive benefits package that includes:

• A competitive salary range of $66,330.00 - $145,860.00, commensurate with experience.
• Eligibility for a CVS Health bonus, commission, or short-term incentive program.
• A full range of medical, dental, and vision benefits.
• A 401(k) retirement savings plan and an Employee Stock Purchase Plan.
• A fully-paid term life insurance plan and short-term and long-term disability benefits.
• Numerous well-being programs, education assistance, and free development courses.
• A CVS store discount and discount programs with participating partners.
• Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year.

Career Growth and Development

As a Medicaid Network Provider Relations Manager at CVS Health, you'll have opportunities to grow your career and develop new skills. Our culture is designed to support your professional journey, with training programs, educational resources, and a collaborative work environment.

Our Work Environment

We pride ourselves on a culture that values diversity, equity, and inclusion. Our remote work arrangement offers flexibility and work-life balance, while our 'Heart At Work Behaviors' ensure that we're always working together to achieve our mission.

Join Our Team!

If you're a compassionate leader with a passion for healthcare, we encourage you to apply for this exciting opportunity. With a strong track record in Provider Relations and a deep understanding of Medicaid Regulatory Standards, you'll be well-equipped to drive success in this role. Don't miss this chance to join our team and make a meaningful difference in the lives of our customers.

Apply now and take the first step towards a rewarding career with CVS Health.