Manager, Provider Relations (Metro, NY)

CVS Health•Staten Island, NY

11d•Remote

About The Position

Aetna is seeking a Manager, Provider Relations to support the Metro New York market. This role is responsible for managing provider relationships and supporting provider service operations for physicians, hospitals, ancillary providers, and health systems. The Manager, Provider Relations serves as a key liaison between providers and internal business partners, driving issue resolution, operational excellence, provider engagement, and network performance. The Manager will collaborate across Network Management, Claims, Operations, Medical Management, Finance, Provider Data, Credentialing, and Contracting teams to resolve complex provider issues, improve provider experience, and support strategic business objectives. The ideal candidate possesses strong analytical and problem-solving skills, healthcare industry knowledge, and the ability to build productive relationships with provider organizations in one of Aetna's largest and most complex markets.

Requirements

4+ years of experience in healthcare operations, provider relations, network management, managed care, claims, provider services, or related healthcare experience.
Demonstrated experience working directly with physicians, hospitals, ancillary providers, or healthcare organizations.
Experience researching and resolving complex operational or provider-related issues.
Strong analytical and problem-solving skills with the ability to evaluate information, identify root causes, and drive resolution.
Understanding of healthcare operations including claims processing, provider enrollment, credentialing, provider data management, and reimbursement fundamentals.
Ability to collaborate effectively across a highly matrixed organization.
Strong verbal, written, and presentation communication skills.
Ability to manage multiple priorities simultaneously and deliver results in a fast-paced environment.
Proficiency with Microsoft Excel, PowerPoint, and data analysis tools.

Nice To Haves

Experience supporting provider organizations within the Metro New York market.
Knowledge of Commercial, Medicare, Medicaid, and ACA products.
Experience resolving provider claims and reimbursement issues.
Experience handling provider disputes, executive complaints, regulatory inquiries, or escalated operational issues.
Familiarity with provider network operations, provider data management, credentialing, and enrollment processes.
Knowledge of value-based care programs and provider performance initiatives.
Experience with provider reporting, operational analytics, and root cause analysis.

Responsibilities

Manage relationships with assigned hospitals
Serve as a primary point of contact for provider operational issues, inquiries, and escalations.
Investigate and resolve complex provider concerns related to claims, rework, appeals, provider data, credentialing, and reimbursement issues.
Partner with cross-functional teams including Claims, Appeals, Operations, Provider Data, Credentialing, Medical Management, and Contracting to drive issue resolution and improve provider experience.
Analyze provider service trends, operational performance, and issue root causes to identify improvement opportunities.
Support provider performance initiatives related to quality, access, operational efficiency, and member experience.
Educate providers on health plan programs, administrative processes, self-service tools, and operational requirements.
Support value-based care initiatives through provider engagement, education, and operational support.
Assist with network adequacy activities, provider recruitment efforts, and regulatory initiatives as needed.
Research and respond to provider complaints, disputes, executive escalations, and regulatory inquiries.
Monitor provider issues through resolution and communicate status updates to internal and external stakeholders.
Support implementation of network and operational initiatives impacting providers.
Prepare provider-facing materials, business summaries, issue analyses, and leadership updates.
Ensure compliance with contractual requirements, regulatory standards, and company policies.
Support special projects and cross-functional initiatives as assigned.