Network Relations Manager, CVS Health

CVS Health

Location:
United States, Massachusetts ▼
Rhode Island

Category:
Health and Beauty

Contract Type:
Employment contract

Salary:

66330.00 - 145860.00 USD / Year

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Job Description:

At CVS Health, we are focused on transforming health care by building a world of health around every consumer through innovative solutions. The role involves managing relationships with providers to ensure operational success and cost-effectiveness, with responsibilities including recruitment, contracting, and compliance oversight. The position demands interaction with key stakeholders and an ability to address complex challenges.

Job Responsibility:

Acts as the primary resource for assigned profile of larger and more complex providers to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding policies and procedures, plan design, contract language, service, claims or compensation issues, and provider education needs
Drives the implementation of internal and external solutions to achieve provider satisfaction, cost targets, network growth, and efficiency targets
Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships
Monitors service capabilities and collaborates cross-functionally to ensure that the needs of constituents are met and that escalated issues related but not limited to, claims payment, contract interpretation or parameters, and accuracy of provider contract or demographic information are resolved
Supports or assists with operational activities that may include, but are not limited to, database management, and contract coordination
Performs credentialing support activities as needed
Educates providers as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, 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
Conduct standard provider recruitment, contracting, or recontracting activities and assist with more complex contracting and discussions as needed by business segment
May provide guidance and training to less experienced team members

Requirements:

4+ years' experience in business segment specific environment servicing or managing non-standard relationships with providers with exposure to benefit plan design and/or contract interpretation
3-5 years' experience with business segment specific policy, benefits, plan design and language
Working knowledge of business segment specific codes, products, and terminology
1-2 years of Medicare and Commercial background

What we offer:

Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost wellness programs including wellness screenings, tobacco cessation, and weight management programs
Confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
May 03, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Network Relations Manager