Senior Manager, Provider Relations Manager (Metro NY)

CVS Health•New York, NY

4d•$82,940 - $199,144•Hybrid

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 person must sit within a commutable distance to the NYC office Position Summary Provides strategic leadership and oversight for network management and provider relations. Develops and implements network strategies, monitors provider performance metrics, leads dispute resolution processes, and collaborates with key stakeholders to drive network growth and ensure high-quality provider relationships.

Requirements

7-10 years of experience in healthcare operations, provider relations, managed care, or network management within a payer or provider organization.
A minimum of 2 years leadership/management experience leading staff to ensure department goals are met.
Demonstrated experience managing provider relationships, including resolving complex service issues, escalations, and provider concerns
Must have provider facing experience.
Ability to travel within the Metro NY market to the NYC office or providers offices as needed.

Nice To Haves

Knowledge of the local market provider community.
Knowledge of Aetna’s internal systems.
Working knowledge of Commercial and Medicare lines of business.

Responsibilities

Manages local provider relations staff to ensure Market Leading Provider Satisfaction scores
Escalations: Provides service to providers by resolving problems and advising providers of new protocols, policies and procedures.
Lead and manage strategic relationships with hospitals, physician groups, and ancillary providers across an assigned market or portfolio.
Conduct shadowing during provider visits on-site, virtual, and telephonic.
Drive provider performance related to quality, cost efficiency, access, and member experience metrics.
Partner closely with Network Management, Medical Management, Value-Based Care, Operations, and Finance to execute provider strategies.
Identify opportunities to improve provider engagement, resolve escalated issues, and strengthen collaboration across the provider network.
Support value-based care initiatives, including education, performance monitoring, and provider adoption of new models.
Analyze provider’s performance data and develop action plans to address gaps or risks.
Serve as a senior point of contact for complex provider concerns or operational challenges.
Work cross functionally with additional teams including claims, appeals, interoperability, and contracting to develop creative solutions and root cause issues
Ensure compliance with regulatory, contractual, and company requirements.