Behavioral Health Provider Relations Lead

CVS Health Corporation; Opelousas (LA); On-site; USD 54,000 - 119,000; Full time

Benefits offered by this job

Benefits package

Bonus program

Job summary

CVS Health Corporation in Louisiana seeks an experienced provider relations professional to act as the primary resource for Medicaid providers and health systems, managing complex issues around policies, contracts, service and claims. You will educate providers, monitor performance, and collaborate with cross-functional teams to meet provider needs.

The role requires strong communication, problem-solving, and negotiation skills, with 5+ years in healthcare and 2+ years in behavioral health

Qualifications

• Minimum 5 years' work experience in healthcare.
• Minimum 3 years' experience in Medicaid Managed Care servicing providers.
• Minimum 2 years' experience working with behavioral health providers and contracts.
• Proficiency with MS Office Suite (Excel, Word, PowerPoint).
• Willingness to travel up to 50-80% of the time.
• Must reside in Louisiana in specified parishes.

Responsibilities

• 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 needs are met and issues are resolved, including claims payment and contract interpretation.
• Supports or assists with operational activities such as database management and contract coordination.
• Performs credentialing support activities as needed.
• Educates Medicaid providers to ensure compliance with contract policies, plan design, and procedures.
• Meets with key providers to ensure service levels meet expectations.
• Manages development of agenda, validates materials, and facilitates external provider meetings.
• Collaborates cross-functionally with implementation of large provider systems to manage cost drivers and trends.
• May provide guidance and training to less experienced team members.

Skills

Healthcare knowledge

Medicaid knowledge

Contract interpretation

Microsoft Office

Travel 50-80%

Education

Bachelor's degree

Tools

Excel

Word

PowerPoint

Job description

CVS Health Corporation in Louisiana seeks an experienced provider relations professional to act as the primary resource for Medicaid providers and health systems, managing complex issues around policies, contracts, service and claims. You will educate providers, monitor performance, and collaborate with cross-functional teams to meet provider needs.

The role requires strong communication, problem-solving, and negotiation skills, with 5+ years in healthcare and 2+ years in behavioral health