Medicaid Provider Network Manager

CVS Health Corporation; Columbus (OH); On-site; USD 60,000 - 133,000; Full time

Job summary

CVS Health in Ohio is seeking an experienced Medicaid professional to support the OhioRISE network. The role focuses on coordinating provider networks, negotiating contracts with local partners, and driving accessible, high‑quality behavioral health services for children with complex needs.

You will partner with MCOs, vendors and ODM, monitor performance against scorecards, and ensure regulatory compliance. Travel within Ohio is required.

Qualifications

• Minimum 5+ years of experience in Medicaid managed care with ability to influence.
• At least 2 years of experience reviewing, analyzing, and auditing healthcare claims data.
• Experience reviewing contracts for compliance with state regulatory requirements.
• Strong communication, critical thinking, problem-resolution and interpersonal skills.
• Candidates must reside in the state of Ohio and be able to travel within the state.
• Proficiency with MS Office Suite applications.

Responsibilities

• Optimizes interactions with providers and internal partners to support business strategy and programs.
• Collaborates cross-functionally to resolve escalated issues for provider systems and monitor performance.
• Educates internal and external parties to ensure contract policy compliance and plan design requirements.
• Meets with key providers to ensure service levels meet expectations.
• Manages agendas, validates materials, and facilitates external provider meetings.
• May collaborate on large provider system implementations to manage cost drivers and data reports.

Skills

Medicaid managed care

Influence / stakeholder management

Claims data analysis

Contract compliance

Communication skills

MS Office

Ohio residency & travel within state

Education

Bachelor's degree

Job description

CVS Health in Ohio is seeking an experienced Medicaid professional to support the OhioRISE network. The role focuses on coordinating provider networks, negotiating contracts with local partners, and driving accessible, high‑quality behavioral health services for children with complex needs.

You will partner with MCOs, vendors and ODM, monitor performance against scorecards, and ensure regulatory compliance. Travel within Ohio is required.