Medicaid Provider Network Manager

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

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.