Medicaid Provider Relations Lead

CVS Health; United States; Remote; USD 60,000 - 133,000; Full time

Job summary

CVS Health is recruiting for a role focused on managing provider relationships within Medicaid, based in the Dallas/Fort Worth area. You will oversee provider communications, contract interpretation, and education needs while coordinating with cross-functional teams to optimize cost, service levels, and provider satisfaction.

The role requires 5+ years in healthcare, 3+ years in Medicaid Managed Care, and willingness to travel up to 80% within the region.

Qualifications

• 5+ years working in healthcare.
• 3+ years in Medicaid Managed Care servicing providers with exposure to benefits/contract interpretation.
• Knowledge of codes, products, and terminology used in the business segment.
• Willingness to travel 50-80% within the defined territory.
• Residence in the Dallas/Fort Worth Metroplex.

Responsibilities

• Serve as the primary resource for assigned providers/groups on Medicaid policies, contracts, and education needs.
• Optimize provider interactions and collaborate with internal partners to meet provider needs and resolve escalated issues (claims, contract interpretation, etc.).
• Support operational activities such as database management and contract coordination; perform credentialing support as needed.
• Educate Medicaid providers to ensure compliance with policies and parameters; meet with key providers to ensure service levels.
• Collaborate cross-functionally with implementation of large provider systems to manage cost drivers and identify trends; may mentor junior staff.

Skills

Communication

Problem solving

Travel ready

Education

Bachelor’s degree preferred

Job description

CVS Health is recruiting for a role focused on managing provider relationships within Medicaid, based in the Dallas/Fort Worth area. You will oversee provider communications, contract interpretation, and education needs while coordinating with cross-functional teams to optimize cost, service levels, and provider satisfaction.

The role requires 5+ years in healthcare, 3+ years in Medicaid Managed Care, and willingness to travel up to 80% within the region.