Network Relations Manager

Were building a world of health around every individual shaping a more connected convenient and compassionate health experience. At CVS Health youll be surrounded by passionate colleagues who care deeply innovate with purpose hold ourselvesaccountable 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.

Position Summary

This is an individual contributor role.

Designs develops maintains and enhances relationships with facilities physicians and ancillary providers which serve as contractual networks of care for members. Manages and maintains relationships with healthcare providers within a network by evaluating provider performance resolving issues or disputes identifying network expansion opportunities and collaborating with internal and external stakeholders.

Primary Job Duties & Responsibilities

• Establishes relationships with network providers fostering open communication and collaboration to ensure a strong network partnership.
• Analyzes network provider performance and quality indicators conducting regular assessments and audits to ensure compliance with contractual obligations and service level agreements.
• Addresses and resolves escalated issues and concerns raised by network providers demonstrating a proactive and customer-centric approach to problem-solving.
• Collaborates with network contracting teams to negotiate and establish contractual terms and conditions with network providers ensuring alignment with organizational goals and objectives.
• Develops tactical and operational plans to expand and enhance the network working closely with business development teams to identify and onboard new providers in strategic areas.
• Monitors and analyzes network data including provider demographics and network adequacy metrics to assess the effectiveness and efficiency of the network and make recommendations for improvements.
• Collaborates with cross-functional teams such as finance operations and customer service to ensure effective coordination and alignment of network-related activities and initiatives.
• Conducts regular meetings with network providers to review performance metrics address concerns and identify opportunities for improvement.
• Stays updated on industry trends regulatory changes and market dynamics that may impact network provider relationships and proactively communicates relevant information to internal stakeholders.

Required Qualifications

• 5 years of experience in healthcare provider relationship management working with individual providers and complex health systems or provider groups to evaluate performance resolve issues identify network growth opportunities and collaborate with key internal and external stakeholders.
• Demonstrated critical thinking problem-solving and decision-making skills with the ability to evaluate information identify root causes develop solutions and make timely decisions with limited supervision.
• Demonstrated ability to collaborate effectively across teams and functions build productive working relationships and contribute toward shared goals and deliverables.
• Proven ability to plan prioritize and execute multiple assignments simultaneously meeting established deadlines and delivering accurate high-quality work.

• Demonstrated written and verbal communication skills with the ability to clearly communicate information recommendations and updates to internal and external stakeholders.
• Proficiency with Microsoft Office Suite including regular use of Outlook and Excel. Excel proficiency should include the ability to organize analyze and summarize data using functions such as formulas filters sorting and pivot tables.
• Demonstrated growth mindset and agility including the ability to adapt to changing priorities incorporate feedback learn new processes and support the development of others.
• Ability and willingness to travel up to 10% based on business needs.

Preferred Qualifications

• Minimum of 2 years of experience reviewing analyzing and auditing healthcare claims and claims data including identifying discrepancies and trends researching and resolving claim issues and providing insights to support accurate and effective claims administration
• Must currently reside in Virginia Washington D.C. Maryland or a state contiguous to one of these locations.

Education

• Bachelors degree preferred/specialized training/relevant professional qualification.

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

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. This position is eligible for a CVS Health bonus commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers patients members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal state and local laws.