Provider Relations Manager

Job Description

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
 
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Position Summary

Acts as the primary resource for assigned, high profile providers and/or groups (i.e. local, individual providers, small groups/systems) to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding Medicaid policies and procedures, plan design, contract language, service, claims or compensation issues, and provider education needs.

• Research and handle contract related issues (ability to research and deep dive). 
• Claims research related to provider set up issues, payment resolutions and coordinate with Claims SME
• Provider visits onsite, virtual, and telephonic 
• Facilitate JOCs and webinars
• Provider orientations/visits
• Provider training
• State projects
• Create and manage provider-facing communications: newsletters, website updates, provider manual, email/fax blast
• Collaborates w/ Quality Management and VBS team to assist w/ facilitation of provider request to enhance quality metrics and relationship building
• Coordinate with Network Management to issue provider CAP
• Monitor Grievances according NCQA standards categories (3 grievances per QTR), including progressive corrective action
• Monitor provider performance in accordance with provider responsibilities policy, contract, state and federal requirements
• Attend Plan committee meetings, as needed
• Re-credentialing non-responder follow up
• Communicate growth partner response to providers
• Manage IPA provider rosters, submit to MPOS
• Document visits/encounters in the appropriate systems (CRM)
• Travel within Market (at least 50%)
• This individual will not have direct reports in this role.

Required Qualifications

• 3+ years’ experience in Medicaid Managed Care business segment environment servicing providers with exposure to benefits and/or contract interpretation
• 3+ years’ of working knowledge of business segment specific codes, products, and terminology
• 3 years of claims experience (professional and institutional).
• Must have the ability to travel at least 50% in the assigned market.

Preferred Qualifications

• Strong verbal and written communication, interpersonal problem resolution and critical thinking skills with proven ability to influence and collaborate with providers at all levels

Education

• Bachelor’s Degree or equivalent combination of education and experience

Pay Range
The typical pay range for this role is: $60,300.00 – $132,600.00.

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. 

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health colleagues can initiate a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through myHR (1-888-694-7287, or through myLeave at myHR). If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.