Manager, Network Relations

CVS Health•Lebanon, NH

8d•$60,300 - $132,600

About The Position

The Manager, Network Relations serves as the primary resource for assigned high-profile providers and provider groups, building and maintaining positive relationships. The role addresses complex issues involving Medicaid policies and procedures, plan design, contract language, service, claims, compensation, and provider education. It works with providers and internal business partners to maintain productive professional relationships and ensure constituent needs are met. The position monitors service capabilities and coordinates across functions to resolve escalated issues, including claims payment, contract interpretation, and provider contract or demographic accuracy. It supports operational work such as database management and contract coordination, provides credentialing support as needed, and educates Medicaid providers on contract requirements, plan design, compensation, technology, policies, and procedures. The role regularly meets with key providers, prepares and facilitates external provider meetings, and collaborates on implementation of large provider systems, cost initiatives, trend identification, and problem resolution. It may also guide and train less experienced team members and collaborate with Provider Enablement & Strategy on provider-facing communications, workflows, trainings, reporting, and HUB support. This is a full-time position, scheduled for 40 hours per week, based in the Dallas/Fort Worth Metroplex. Travel within the defined territory is required up to 50–80% of the time.

Requirements

At least 5 years of work experience in healthcare.
At least 3 years of experience in a Medicaid Managed Care business segment environment servicing providers, with exposure to benefits and/or contract interpretation.
Working knowledge of business-segment-specific codes, products, and terminology.
Strong verbal and written communication, interpersonal, problem-resolution, and critical-thinking skills.
Travel within the defined territory up to 50–80% of the time.
Must reside in the Dallas/Fort Worth Metroplex.

Nice To Haves

Knowledge of Medicaid regulatory standards for Network Access, Credentialing, Claim Lifecycle, Provider Appeals & Disputes, and Network Performance Standards.
Experience with medical terminology and CPT, ICD-10, and similar codes.
Bachelor's degree, or a combination of professional work experience and education.

Responsibilities

Serve as the primary resource for assigned high-profile providers and groups, addressing complex issues involving Medicaid policies and procedures, plan design, contract language, service, claims, compensation, and provider education.
Build and maintain productive, professional relationships with providers and internal business partners.
Monitor service capabilities and collaborate cross-functionally to meet constituent needs and resolve escalated issues involving claims payment, contract interpretation or parameters, and provider contract or demographic information.
Support operational activities, including database management and contract coordination.
Perform credentialing support activities as needed.
Educate Medicaid providers on contract policies and parameters, plan design, compensation processes, technology, policies, and procedures.
Meet regularly with key providers to ensure service levels meet expectations.
Develop meeting agendas, validate materials, and facilitate external provider meetings.
Collaborate on implementation of large provider systems, management of cost drivers, and execution of cost initiatives supporting business objectives.
Identify trends and enlist assistance to resolve problems.
Provide guidance and training to less experienced team members as needed.
Collaborate with Provider Enablement & Strategy on provider-facing communications, desktops, workflows, external trainings, reporting needs, and HUB support.
Perform other duties as assigned.