Provider Network Relationship Manager (Ohio)

CVS Health • Dayton, OH

3d

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: As part of the bold vision to deliver the “Next Generation” of managed care in Ohio Medicaid, Ohio RISE will help struggling children and their families by focusing on the individual with strong coordination and partnership among MCOs, vendors, and ODM to support specialization in addressing critical needs. The OhioRISE Program is designed to provide comprehensive and highly coordinated behavioral health services for children with serious/complex behavioral health needs involved in, or at risk for involvement in, multiple child-serving systems. This is an individual contributor role. This position assesses overall network composition and potential provider partners in order to identify and service partnerships that will advance and differentiate the OhioRISE Network. This executes, services and may negotiate contracts with local market providers in accordance with company and program standards to enhance provider networks and exceed accessibility, quality, and financial goals and cost initiatives.

Requirements

• 5+ years of experience in Medicaid managed care, with a strong ability to influence and a proven track record of successfully negotiating and managing contracts with individual providers and complex provider systems or groups.
• Experience in Behavioral Health contracting is strongly preferred.
• Understands the regulatory environment and ensures contractual compliance with state requirements.
• Strong communication, critical thinking, problem resolution and interpersonal skills.
• Candidates must reside in the state of Ohio.
• Ability to travel in-state as needed.
• Computer literate; proficiency with MS Office Suite applications.

Nice To Haves

• In depth knowledge of behavioral health market and strong experience building and maintaining relationships with Behavioral Health providers.
• In depth knowledge of Ohio managed care market, Medicaid preferred.

Responsibilities

• Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships and partners on the development of business strategy and programs to support the operational plans.
• Collaborates cross-functionally to ensure resolution of escalated issues or projects for assigned provider systems and monitors performance and adherence to scorecards and payout schedules based on established quality, growth, and clinical measures.
• Educates internal and external parties as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, performance measurement techniques, policies, and procedures.
• Meets with key providers periodically to ensure service levels are meeting expectations.
• Manages the development of agenda, validates materials, and facilitates external provider meetings.
• May collaborate cross-functionally on the implementation of large provider systems, to manage cost drivers, data reports and execute specific cost initiatives to support business objectives and to identify trends and enlist assistance in problem resolution.
• May be responsible for provider recruitment, contracting, or re-contracting activities, or may assist and support more complex contracting and discussions.
• Drives provider engagement, and may recruit providers, as needed to ensure attainment of network expansion and adequacy targets.
• Assists with the design, development, management, and or implementation of strategic network configurations and integration activities.
• Serves as SME for less experienced team members and internal partners.

Benefits

• This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families.
• The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
• Additional details about available benefits are provided during the application process and on Benefits Moments.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level