CVS Health
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Network Relations Manager
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CVS Health 3 days ago Be among the first 25 applicants Join to apply for the
Network Relations Manager
role at
CVS Health Get AI-powered advice on this job and more exclusive features. Optimizes interaction 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 the 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 to ensure compliance with contract policies and parameters, plan design, compensation process, technology, policies, and procedures. Meets with key providers to ensure service levels are meeting expectations. Manages the development of agenda, validates materials, and facilitates external provider meetings and JOCs. May collaborate cross-functionally on the implementation of large provider systems, to manage cross drivers and execute specific cost initiatives to support business objective and to identify trends and enlist assistance in problem resolution. Responsibilities include research and handling contract related issues, claims research related to provider set up issues, payment resolutions and coordination with Claims SME, provider visits onsite, virtual, and telephonic, facilitating JOCs and webinars, provider orientations/visits, provider training, state projects, creating and managing provider-facing communications such as newsletters, website updates, provider manual, email/fax blasts, collaborating with Quality Management and VBS team to assist with facilitation of provider requests to enhance quality metrics and relationship building, coordinating with Network Management to issue provider CAP, monitoring grievances according to NCQA standards categories, monitoring provider performance in accordance with provider responsibilities policy, contract, state and federal requirements, attending Plan committee meetings as needed, recredentialing non-responder follow up, communicating growth partner response to providers, managing IPA provider rosters and submitting to MPOS, documenting visits/encounters in the appropriate systems (CRM), traveling within Market, and other duties as assigned. Job requirements include 3 years' experience in business segment environment servicing providers with exposure to benefits and/or contract interpretation, 3-5 years' experience with business segment specific policy, benefits plan design and language, strong verbal and written communication, interpersonal problem resolution and critical thinking skills, working knowledge of business segment specific codes, products and terminology, bilingual (English and Spanish) preferred. Education requirement is a Bachelor's degree or an equivalent combination of formal education and experience. Seniority level
Seniority level Mid-Senior level Employment type
Employment type Full-time Job function
Job function Sales and Business Development Industries Hospitals and Health Care Referrals increase your chances of interviewing at CVS Health by 2x Sign in to set job alerts for “Relationship Manager” roles.
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Network Relations Manager
role at
CVS Health 3 days ago Be among the first 25 applicants Join to apply for the
Network Relations Manager
role at
CVS Health Get AI-powered advice on this job and more exclusive features. Optimizes interaction 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 the 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 to ensure compliance with contract policies and parameters, plan design, compensation process, technology, policies, and procedures. Meets with key providers to ensure service levels are meeting expectations. Manages the development of agenda, validates materials, and facilitates external provider meetings and JOCs. May collaborate cross-functionally on the implementation of large provider systems, to manage cross drivers and execute specific cost initiatives to support business objective and to identify trends and enlist assistance in problem resolution. Responsibilities include research and handling contract related issues, claims research related to provider set up issues, payment resolutions and coordination with Claims SME, provider visits onsite, virtual, and telephonic, facilitating JOCs and webinars, provider orientations/visits, provider training, state projects, creating and managing provider-facing communications such as newsletters, website updates, provider manual, email/fax blasts, collaborating with Quality Management and VBS team to assist with facilitation of provider requests to enhance quality metrics and relationship building, coordinating with Network Management to issue provider CAP, monitoring grievances according to NCQA standards categories, monitoring provider performance in accordance with provider responsibilities policy, contract, state and federal requirements, attending Plan committee meetings as needed, recredentialing non-responder follow up, communicating growth partner response to providers, managing IPA provider rosters and submitting to MPOS, documenting visits/encounters in the appropriate systems (CRM), traveling within Market, and other duties as assigned. Job requirements include 3 years' experience in business segment environment servicing providers with exposure to benefits and/or contract interpretation, 3-5 years' experience with business segment specific policy, benefits plan design and language, strong verbal and written communication, interpersonal problem resolution and critical thinking skills, working knowledge of business segment specific codes, products and terminology, bilingual (English and Spanish) preferred. Education requirement is a Bachelor's degree or an equivalent combination of formal education and experience. Seniority level
Seniority level Mid-Senior level Employment type
Employment type Full-time Job function
Job function Sales and Business Development Industries Hospitals and Health Care Referrals increase your chances of interviewing at CVS Health by 2x Sign in to set job alerts for “Relationship Manager” roles.
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Miami, FL $100,000.00-$165,000.00 4 weeks ago JPMorgan Private Client Relationship Manager – Miami, FL
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