Network Relations Manager – Jacksonville or Orlando, Florida Area

CVS Health•Winter Park, FL

2d•$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. This is an individual contributor role. The Manager, Network Relations role is critical in advancing the organization’s Value-Based Contracting (VBC) strategy for the Rest of FL Market. This position is essential to developing and managing provider relationships that drive improved health outcomes, cost efficiency, and overall VBC strategies within the state.

Requirements

Minimum 7 years of experience in healthcare quality, risk adjustment, or compliance within a Medicare Advantage setting.
Minimum 5 years of experience in provider relationship management, network management, or provider services within a healthcare environment.
Strong understanding of CMS regulations, HEDIS, STAR ratings, and provider engagement strategies.
Demonstrated ability to analyze financial and quality performance data and implement process improvements.
Must reside within the Florida market, with a preference for candidates located in the Jacksonville or Orlando areas.

Nice To Haves

Experience with Commercial and Medicare lines of business.
Ability to build collaborative relationships with providers and work cross-functionally to resolve complex provider contract issues.
Highly organized and able to successfully manage and prioritize multiple negotiations, issues, and other tasks to ensure completion and meet deadlines.

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.
Develop 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.
Stay updated on industry trends, regulatory changes, and market dynamics that may impact network provider relationships, and proactively communicate relevant information to internal stakeholders.