Manager, Network Relations

CVS Health•Chalmers, IL

8d•Onsite

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Acts as the primary resource for assigned, high profile providers or groups (i.e. local, individual providers, small groups/systems) to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding policies and procedures, plan design, contract language, service, claims or compensation issues, and provider education needs.

Requirements

Strong knowledge of business segment specific codes, products, and terminology
5+ years' experience with business segment specific policy, benefits, plan design and language
Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills
5+ years in external-facing customer service working with providers

Nice To Haves

3+ years' experience in business segment environment servicing providers with exposure to benefits and/or contract interpretation

Responsibilities

Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships.
Monitors service capabilities and collaborates cross-functionally to ensure that the needs of constituents are met and that escalated issues related but not limited to, claims payment, contract interpretation or parameters, and accuracy of provider contract or demographic information are resolved.
Supports or assists with operational activities that may include, but are not limited to, database management, and contract coordination.
Performs credentialing support activities as needed.
Educates providers as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, policies, and procedures.
Meets with key providers periodically to ensure service levels are meeting expectations.
Manages the development of agenda, validates materials, and facilitates external provider meetings.
Will collaborate cross-functionally on the implementation of products, contracts or provider demographic updates
Sought out as a subject matter expert within the team for progress, program overviews, and state-specific contractual requirements
Responsible for onboarding new staff, facilitating on-going training
Position will attend and interact with external/state facilitated calls, working sessions and Joint Operating Committees