Manager, Network Relations

CVS Health; Oregon; Hybrid; USD 60,000 - 133,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Retirement savings

Paid time off

Job summary

CVS Health in Dallas/Fort Worth is seeking an experienced Provider Relations professional to serve as the primary resource for Medicaid providers and groups, guiding them through contract language, plan design, service and claims issues while educating on policies and parameters. Requirements include at least 5 years in healthcare, a minimum of 3 years in Medicaid Managed Care, travel up to 50–80%, and residency in the Dallas/Fort Worth Metroplex.

A Bachelor's degree is preferred.

Qualifications

• Minimum of 5 years' work experience in healthcare.
• Minimum of 3 years' experience in Medicaid Managed Care servicing providers.
• Travel within the defined territory up to 50-80%.
• Must reside in the Dallas/Fort Worth Metroplex.

Responsibilities

• Acts as the primary resource for assigned providers and/or groups to address complex issues about Medicaid policies, plan design, contract language, service, claims or compensation, and provider education needs.
• Optimizes interactions with providers and internal partners to maintain productive relationships.
• Supports credentialing and contract coordination; educates providers on policies and parameters.
• Meets with key providers, manages agendas, and facilitates external provider meetings.
• Collaborates with cross-functional teams on large provider system implementations and cost initiatives.

Skills

Healthcare experience

Provider relations

Communication skills

Problem solving

Education

Bachelor's degree preferred

Job description

We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable 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

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 collaborate 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 meet expectations.
• Manages the development of agenda, validates materials, and facilitates external provider meetings.
• Collaborate cross-functionally with 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.
• May provide guidance and training to less experienced team members.
• Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills.
• Collaborate with Provider Enablement & Strategy on Provider-facing communications, desktops, workflows, external trainings, reporting needs, and HUB support.
• Other duties as assigned.

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 the defined territory up to 50-80% of the time.
• Must reside in the Dallas/Fort Worth Metroplex

Preferred Qualifications

• Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claim Lifecycle, Provider Appeals & Disputes, and Network Performance Standards.
• Experience in Medical Terminology, CPT, ICD-10 codes, etc.

Education

Bachelor's degree preferred or a combination of professional work experience and education.

Anticipated Weekly Hours

40

Time Type

Full time

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. 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 peopleWe take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments .We anticipate the application window for this opening will close on: 12/31/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.