Manager, Network Relations

CVS Health; United States; Remote; USD 54,000 - 146,000; Full time

Job summary

CVS Health is seeking a Provider Relations Specialist focused on managing relationships with complex providers and handling issues related to policies and plans. Join a team dedicated to enhancing healthcare experiences through effective collaboration and education.

Benefits

Affordable medical plan options

401(k) plan with company contributions

Employee stock purchase plan

Flexible work schedules

Tuition assistance

Qualifications

• 4 to 5 years of provider relations experience.
• 3 to 5 years' business policy and plan design experience.
• Working knowledge of CPT and HCPC codes.

Responsibilities

• Acts as primary resource for complex provider relationships.
• Drives internal solutions for provider satisfaction and network growth.
• Educates providers on compliance with contract policies.

Skills

Problem Solving

Conflict Management

Communication

Education

Bachelor’s Degree

Tools

EPDB

Job description

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

Acts as the primary resource for assigned profile of larger and more complex providers (i.e. market/ regional/national, large physician group or

Hospital systems) to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding policies and

procedures, plan design, contract language, service, claims or compensation issues, and provider education needs.

- Drives the implementation of internal and external solutions to achieve provider satisfaction, cost targets, network growth, and efficiency

targets.

- 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 providers as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, policies, and procedures.

- Meets with key providers periodically to ensure service levels are meeting expectations.

- Manages the development of agenda, validates materials, and facilitates external provider meetings.

- Conduct standard provider recruitment, contracting, or re-contracting activities and assist with more complex contracting and discussions as needed by business segment.

- May provide guidance and training to less experienced team members

Required Qualifications

• 4 to 5 years of provider relations experience- servicing or managing non-standard relationships with providers with exposure to benefit plan design and/or contract interpretation.
• 3 to 5 years' experience with business segment specific policy, benefits, plan design and language.
• Working knowledge of business segment specific CPT and HCPC codes, products, and terminology.
• Proven advanced problem-solving skills, conflict management, an independent worker and self-starter.
• Ability to work remotely, in the Maine, Connecticut, Rhode Island, Massachusetts, New Hampshire and Vermont area.

Preferred Qualifications

• 2+ years of Medicare and Commercial insurance experience
• Ability to educate an outcome or position even if unfavorable.
• Ability to evaluate data and identify action plans or solutions based on data.
• Previous experience using EPDB and provider on-boarding tools

Education

• Bachelor’s Degree or equivalent combination of education and experience.

Anticipated Weekly Hours

40

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

Acts as the primary resource for assigned profile of larger and more complex providers (i.e. market/ regional/national, large physician group or

Hospital systems) to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding policies and

procedures, plan design, contract language, service, claims or compensation issues, and provider education needs.

- Drives the implementation of internal and external solutions to achieve provider satisfaction, cost targets, network growth, and efficiency

targets.

- 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 providers as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, policies, and procedures.

- Meets with key providers periodically to ensure service levels are meeting expectations.

- Manages the development of agenda, validates materials, and facilitates external provider meetings.

- Conduct standard provider recruitment, contracting, or re-contracting activities and assist with more complex contracting and discussions as needed by business segment.

- May provide guidance and training to less experienced team members

Required Qualifications

• 4 to 5 years of provider relations experience- servicing or managing non-standard relationships with providers with exposure to benefit plan design and/or contract interpretation.
• 3 to 5 years' experience with business segment specific policy, benefits, plan design and language.
• Working knowledge of business segment specific CPT and HCPC codes, products, and terminology.
• Proven advanced problem-solving skills, conflict management, an independent worker and self-starter.
• Ability to work remotely, in the Maine, Connecticut, Rhode Island, Massachusetts, New Hampshire and Vermont area.

Preferred Qualifications

• 2+ years of Medicare and Commercial insurance experience
• Ability to educate an outcome or position even if unfavorable.
• Ability to evaluate data and identify action plans or solutions based on data.
• Previous experience using EPDB and provider on-boarding tools

Education

• Bachelor’s Degree or equivalent combination of education and experience.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$54,300.00 - $145,860.00

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 people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 08/31/2025

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

About the company

At CVS Health, we share a clear purpose: helping people on their path to better health. Through our health services, plans and community pharmacists, we’re pioneering a bold new approach to total health. Making quality care more affordable, accessible, simple and seamless, to not only help people get well, but help them stay well in body, mind and spirit.

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