Mgr,Network Relations

CVS Health•Work At Home-Arizona, AZ

4d•$60,300 - $132,600•Remote

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.

Requirements

Must reside in Arizona, Northern Arizona preferred.
5-7 years prior work experience in a healthcare environment.
Ability to travel up to 50% of time within Arizona
Adept at problem solving and decision making skills
Adept at growth mindset (agility and developing yourself and others) skills
Adept at execution and delivery (planning, delivering, and supporting) skills

Nice To Haves

Certified Billing and Coding Specialist (CBCS) preferred.

Responsibilities

Designs, develops, contracts, maintains and enhances relationships with facilities, physicians and ancillary providers which serve as contractual networks of care for members.
Manages and maintains relationships with healthcare providers within a network by negotiating contracts, evaluating provider performance, resolving issues or disputes, identifying network expansion opportunities, and collaborating with internal and external stakeholders.
Establishes relationships with network providers, fostering open communication and collaboration to ensure a strong network partnership.
Analyzes network provider performance and quality indicators, conducting regular assessments and audits to ensure compliance with contractual obligations and service level agreements.
Addresses and resolves escalated issues and concerns raised by network providers, demonstrating a proactive and customer-centric approach to problem-solving.
Collaborates with network contracting teams to negotiate and establish contractual terms and conditions with network providers, ensuring alignment with organizational goals and objectives.
Develops tactical and operational plans to expand and enhance the network, working closely with business development teams to identify and onboard new providers in strategic areas.
Monitors and analyzes network data, including provider demographics and network adequacy metrics, to assess the effectiveness and efficiency of the network and make recommendations for improvements.
Collaborates with cross-functional teams, such as finance, operations, and customer service, to ensure effective coordination and alignment of network-related activities and initiatives.
Conducts regular meetings and performance reviews with network providers to review performance metrics, address concerns, and identify opportunities for improvement.
Stays updated on industry trends, regulatory changes, and market dynamics that may impact network provider relationships, and proactively communicates relevant information to internal stakeholders.