Manager, Network Relations

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Requisition Job Description

Position Summary

This role acts as the primary resource for an assigned profile of large provider groups/health systems to establish, oversee, and maintain provider risk management and positive relationships and supports high value initiative activities. Drives the implementation of internal and external solutions to achieve provider satisfaction, cost targets, network growth, and efficiency targets.

• Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships.
• Manges provider servicing matters; collaborates cross-functionally to ensure that the needs of constituents are met by driving resolutions for escalated issues related to claims payment, policies, accuracy of provider demographic information and contract interpretation.
• Educates providers to ensure compliance with contract parameters, plan design, compensation process, technology, policies, and procedures.
• Manages the development of agendas, validates materials, and facilitates external provider meetings to ensure service levels are meeting expectations.
• May collaborate cross functionally to manage cost drivers and execute specific cost initiatives to support business objectives and identify trends to enlist assistance in problem resolution.
• Other duties as assigned

Required Qualifications

• Strong verbal and written communication, interpersonal, conflict resolution and critical thinking skills with proven ability to influence and collaborate with providers and partners at all levels.
•  3 to 5 years of provider relations experience- non-standard relationships with providers with exposure to benefit plan design and/or contract interpretation.
• Working knowledge of business segment specific CPT and HCPC codes, products, and terminology.
• Proven advanced problem-solving skills, conflict management, an independent worker and self-starter.
• Prior Medicare and Commercial insurance experience
• Must be willing to travel 10-15% to providers.
• Ability to work remotely,  in the Virginia, Maryland, or District of Columbia area.

Preferred Qualifications

• Ability to educate an outcome or position even if unfavorable.
• Ability to evaluate data and identify action plans or solutions based on data.

Education

• Bachelor's degree or equivalent professional work experience.

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

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.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.