Provider Network Growth & Partnerships Manager

4004 Aetna Medicaid Administrators; Kentucky; Hybrid; USD 60,000 - 133,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is pursuing a key role within the OhioRISE program, focusing on Medicaid managed care and strong provider partnerships. This individual contributor position emphasizes network development, contract analysis, and collaboration with MCOs, vendors, and ODM to deliver high-quality behavioral health services for children with complex needs.

The role requires extensive knowledge of Medicaid rules, robust stakeholder engagement, and the ability to travel within Ohio.

Qualifications

• 5+ years of experience in Medicaid managed care.
• Experience reviewing, analyzing, and auditing healthcare claims/data.
• Ability to review contracts for compliance and identify issues.

Responsibilities

• Optimizes interactions with providers and internal partners to develop business strategy and programs.
• Collaborates cross-functionally to resolve escalated issues and monitor performance against quality, growth, and financial goals.
• May negotiate contracts with local market providers to enhance networks and cost initiatives.
• Serves as SME to mentor less experienced team members.

Education

Bachelor’s degree preferred

Job description

CVS Health is pursuing a key role within the OhioRISE program, focusing on Medicaid managed care and strong provider partnerships. This individual contributor position emphasizes network development, contract analysis, and collaboration with MCOs, vendors, and ODM to deliver high-quality behavioral health services for children with complex needs.

The role requires extensive knowledge of Medicaid rules, robust stakeholder engagement, and the ability to travel within Ohio.