Network Relations Manager (Central and Northeast Florida)

CVS Health • Orlando, FL

28d

About The Position

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.This is an individual contributor role. Acts as the primary resource for assigned providers and/or groups to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues, regarding policies and procedures, contract language, service, claims or compensation issues, and provider education needs. Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships. Meets with key Providers at regular intervals to ensure service levels meet expectations. Collaborates with internal stakeholders to address provider-related issues, streamline processes, and improve the overall provider experience within the organization.Contributes to the development and expansion of the healthcare organization's provider network by identifying and recruiting new providers who align with the organization's needs and strategic objectives.Coordinates the contracting process with healthcare providers to negotiate contract terms, fee schedules, reimbursement rates, and other contractual arrangements.Assists with the development of provider education programs by organizing meetings, webinars, or training sessions to enhance providers' understanding of the organization's requirements, quality standards, and best practices.Handles provider-related issues, concerns, and disputes to maintain positive relationships and ensure compliance with contractual agreements.Supports or assists with operational activities that may include, but are not limited to, database management, and contract coordination.Performs limited credentialing support activities as needed. Manages the development of agenda, validates materials, and facilitates external provider meetings. Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills.Other duties as assigned.

Requirements

• A minimum of 5 years' work experience in healthcare.
• Minimum of 3 years' experience in Managed Care & Medicare business segment environment servicing providers with exposure to contracting and contract management.
• Working knowledge of business segment, products, and terminology.
• Travel within the defined territory up to 30% - 50% of the time.
• Candidates must reside in Central Florida (Orlando area) or Northeast Florida (Jacksonville area).

Nice To Haves

• Bilingual in Spanish highly preferred.
• Proficient in the MS Office Suite and other advanced technologies.
• Bachelor's degree preferred or a combination of professional work experience and education.

Responsibilities

• Acts as the primary resource for assigned providers and/or groups to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues, regarding policies and procedures, contract language, service, claims or compensation issues, and provider education needs.
• Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships.
• Meets with key Providers at regular intervals to ensure service levels meet expectations.
• Collaborates with internal stakeholders to address provider-related issues, streamline processes, and improve the overall provider experience within the organization.
• Contributes to the development and expansion of the healthcare organization's provider network by identifying and recruiting new providers who align with the organization's needs and strategic objectives.
• Coordinates the contracting process with healthcare providers to negotiate contract terms, fee schedules, reimbursement rates, and other contractual arrangements.
• Assists with the development of provider education programs by organizing meetings, webinars, or training sessions to enhance providers' understanding of the organization's requirements, quality standards, and best practices.
• Handles provider-related issues, concerns, and disputes to maintain positive relationships and ensure compliance with contractual agreements.
• Supports or assists with operational activities that may include, but are not limited to, database management, and contract coordination.
• Performs limited credentialing support activities as needed.
• Manages the development of agenda, validates materials, and facilitates external provider meetings.
• Other duties as assigned.

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Ambulatory Health Care Services
• Number of Employees: 5,001-10,000 employees