CVS Health
Manager, Network Relations - (Oklahoma)
CVS Health - Tulsa, Oklahoma, United States, 74145
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Manager, Network Relations - (Oklahoma)
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Manager, Network Relations - (Oklahoma)
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CVS Health Get AI-powered advice on this job and more exclusive features. 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. 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 Medicaid providers as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, policies, and procedures. Meets with key providers at regular intervals to ensure service levels are meeting expectations. Manages the development of agenda, validates materials, and facilitates external provider meetings. Collaborates cross-functionally on the implementation of large provider systems, to manage cost drivers and execute specific cost initiatives to support business objectives and to identify trends and enlist assistance in problem resolution. Assists with standard provider recruitment, contracting, or re-contracting activities and assists with more complex contracting and discussions as needed by business segment. May provide guidance and training to less experienced team members. Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills. Required Qualifications: A minimum of 5 years work experience in healthcare. Minimum of 3 years' experience in Medicaid Managed Care business segment environment servicing providers with exposure to benefits and/or contract interpretation. Working knowledge of business segment specific codes, products, and terminology. Travel within defined territory up to 50% of the time. Preferred Qualifications: Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and Network Performance Standards. Education: Bachelor's degree preferred or a combination of professional work experience and education. Seniority level
Seniority level Mid-Senior level Employment type
Employment type Full-time Job function
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Manager, Network Relations - (Oklahoma)
role at
CVS Health 1 day ago Be among the first 25 applicants Join to apply for the
Manager, Network Relations - (Oklahoma)
role at
CVS Health Get AI-powered advice on this job and more exclusive features. 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. 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 Medicaid providers as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, policies, and procedures. Meets with key providers at regular intervals to ensure service levels are meeting expectations. Manages the development of agenda, validates materials, and facilitates external provider meetings. Collaborates cross-functionally on the implementation of large provider systems, to manage cost drivers and execute specific cost initiatives to support business objectives and to identify trends and enlist assistance in problem resolution. Assists with standard provider recruitment, contracting, or re-contracting activities and assists with more complex contracting and discussions as needed by business segment. May provide guidance and training to less experienced team members. Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills. Required Qualifications: A minimum of 5 years work experience in healthcare. Minimum of 3 years' experience in Medicaid Managed Care business segment environment servicing providers with exposure to benefits and/or contract interpretation. Working knowledge of business segment specific codes, products, and terminology. Travel within defined territory up to 50% of the time. Preferred Qualifications: Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and Network Performance Standards. Education: Bachelor's degree preferred or a combination of professional work experience and education. Seniority level
Seniority level Mid-Senior level Employment type
Employment type Full-time Job function
Job function Information Technology Industries Hospitals and Health Care Referrals increase your chances of interviewing at CVS Health by 2x Get notified about new Network Manager jobs in
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