Senior Manager, Provider Relations (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. Candidate must be within a commutable distance to the NYC office Position Summary Lead provider relationship management and service operations, driving issue resolution, provider satisfaction, and cross-functional coordination for complex provider groups. This position is primarily remote with the understanding and willingness to travel to the office as needed.

Requirements

7-10 years of experience in healthcare operations, provider relations, managed care, or network management within a payer or provider organization
Demonstrated experience managing provider relationships, including resolving complex service issues, escalations, and provider concerns
Strong understanding of healthcare operations, including: Claims processing and issue resolution, provider service models and workflows
Experience handling high-level escalations, including executive complaints, regulatory inquiries, and provider disputes
Strong analytical and problem-solving skills with the ability to interpret complex data and resolve issues
Ability to travel within Metro NY market as needed to the NYC office or providers offices.

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

Lead and manage strategic relationships with hospitals, physician groups, and ancillary providers across an assigned market or portfolio.
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.