Senior Manager, Provider Relations

CVS Health•Work At Home-Texas, TX

4d•$75,400 - $165,954•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.

Requirements

Must reside in the State.
A minimum of 7 years' work experience in healthcare.
Must have working knowledge of Medicaid.
A minimum of 2 years leadership/management experience leading / managing staff to ensure department goals are met.
Must have provider facing experience
Travel within Market as needed.
This position must reside in Texas within driving distance of HHSC State buildings.
Strong communication, critical thinking, problem resolution, interpersonal skills, organizational and time management skills.
Team player with proven ability to develop strong working relationships within a fast-paced, matrix organization.
Demonstrated ability to influence and collaborate with internal and external partners via strong written and verbal communications.

Nice To Haves

Demonstrated ability to identify and manage initiatives that improve total medical cost and quality.
Experience in managed care and provider engagement.
Knowledge of the local market provider community.
Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes, and Network Performance Standards.
Experience in Medical Terminology, CPT, ICD-10 codes, etc.
Bachelor's degree preferred or a combination of professional work experience and education.

Responsibilities

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.
Manages local provider relations staff to ensure Market Leading Provider Satisfaction scores
Provides service to providers by resolving problems and advising providers of new protocols, policies and procedures.
Assist in creation of reports, attend, and present at Plan committee meetings (Grievance, SIC, etc.)
Coordinate Provider information with member services and other internal departments as requested.
Conduct shadowing during provider visits on-site, virtual, telephonic.
Monitor after-visit provider survey.
Collaborate with leadership to maintain and update policies and procedures to ensure alignment with organizational standards and regulatory requirements.
Assist Providers by resolving inquiries and educating Providers on new protocols, policies, and procedures.
Active participation in State and regulatory audits.
Conference participation, as needed.
Lead process improvement initiatives across the Provider Engagement team to increase operational efficiency, provider satisfaction, and compliance.
Identify gaps, streamline workflows, and implement standardized processes to support PE team objectives.
Develop and maintain operational procedures, desktop guides, and best practices for the PE team.
Monitor performance metrics and recommend improvements to engagement strategies and team effectiveness.
Monitor Texas Health and Human Services Commission (HHSC) updates, requirements, and regulatory changes impacting provider operations.
Translate regulatory requirements into actionable guidance for the Provider Engagement team.
Develop, update, and maintain PE desktop procedures, reference materials, and training resources.
Ensure provider-facing communications and educational materials align with state directives and organizational standards.