Network Relations Manager

CVS Health•Carolina, NC

1d•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. Position Summary This is an individual contributor role. Designs, develops, 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 evaluating provider performance, resolving issues or disputes, identifying network expansion opportunities, and collaborating with internal and external stakeholders.

Requirements

5+ years of experience in healthcare provider relationship management, working with individual providers and complex health systems or provider groups to evaluate performance, resolve issues, identify network growth opportunities, and collaborate with key internal and external stakeholders.
Demonstrated critical thinking, problem-solving, and decision-making skills, with the ability to evaluate information, identify root causes, develop solutions, and make timely decisions with limited supervision.
Demonstrated ability to collaborate effectively across teams and functions, build productive working relationships, and contribute toward shared goals and deliverables.
Proven ability to plan, prioritize, and execute multiple assignments simultaneously, meeting established deadlines and delivering accurate, high-quality work.
Demonstrated written and verbal communication skills, with the ability to clearly communicate information, recommendations, and updates to internal and external stakeholders.
Proficiency with Microsoft Office Suite, including regular use of Outlook and Excel. Excel proficiency should include the ability to organize, analyze, and summarize data using functions such as formulas, filters, sorting, and pivot tables.
Demonstrated growth mindset and agility, including the ability to adapt to changing priorities, incorporate feedback, learn new processes, and support the development of others.
Ability and willingness to travel up to 10%, based on business needs.

Nice To Haves

Minimum of 2 years of experience reviewing, analyzing, and auditing healthcare claims and claims data, including identifying discrepancies and trends, researching and resolving claim issues, and providing insights to support accurate and effective claims administration
Must currently reside in Virginia, Washington, D.C., Maryland, or a state contiguous to one of these locations.

Responsibilities

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 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.