Manager, Network Relations

CVS Health; Texas; On-site; USD 60,000 - 133,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Other resources

Job summary

CVS Health is seeking a Medicaid Provider Relations professional in the Dallas/Fort Worth area. The role focuses on establishing and maintaining positive relationships with assigned providers and groups, addressing complex issues related to Medicaid policies, contracts, and service while coordinating with internal partners to meet provider needs.

Regular meetings and training will be part of the responsibilities.

Qualifications

• A minimum of 5 years' work experience in healthcare.
• Minimum of 3 years' experience in Medicaid Managed Care environment servicing providers with exposure to benefits and/or contract interpretation.
• Working knowledge of business segment specific codes, products, and terminology.

Responsibilities

• Act as the primary resource for assigned providers or groups to establish, oversee and maintain relationships and respond to complex issues including Medicaid policies, plan design, contract language and education needs.
• Monitor service capabilities and collaborate cross-functionally to ensure provider needs are met and issues such as claims payment and contract interpretation are resolved.
• Support operational activities which may include database management and contract coordination; perform credentialing support as needed.
• Educate Medicaid providers to ensure compliance with contract policies and parameters, plan design, compensation processes and procedures.
• Meet with key providers regularly to ensure service levels meet expectations and manage provider communications and training.
• Collaborate with cross-functional teams on large provider system implementations to manage cost drivers and identify trends.

Skills

Healthcare experience

Medicaid knowledge

Contract interpretation

Education

Bachelor's degree

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.

Great benefits for great people

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.

• Medical coverage
• Dental coverage
• Vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources

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: 12/31/2026

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

Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.