Provider Relations Manager, Healthcare Network

CVS Health; Trenton (NJ); On-site; USD 66,000 - 159,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement plan

Job summary

CVS Health is seeking a Manager, Provider Relations to support the Metro New York market. This role manages provider relationships and supports provider service operations for physicians, hospitals, and health systems, collaborating with multiple internal teams to resolve issues and improve network performance.

The ideal candidate has 4+ years in healthcare operations or provider relations, strong analytical skills, and proficient Excel/PowerPoint abilities.

Qualifications

• Bachelor's degree or equivalent combination of education and relevant professional experience.
• 4+ years of experience in healthcare operations, provider relations, network management, managed care, claims, provider services, or related healthcare experience.
• Experience researching and resolving complex operational or provider-related issues.
• Strong analytical and problem-solving skills with the ability to evaluate information, identify root causes, and drive resolution.
• Understanding of healthcare operations including claims processing, provider enrollment, credentialing, provider data management, and reimbursement fundamentals.

Responsibilities

• Manage relationships with assigned hospitals.
• Serve as a primary point of contact for provider operational issues, inquiries, and escalations.
• Investigate and resolve complex provider concerns related to claims, rework, appeals, provider data, credentialing, and reimbursement issues.
• Partner with cross-functional teams including Claims, Appeals, Operations, Provider Data, Credentialing, Medical Management, and Contracting to drive issue resolution and improve provider experience.
• Analyze provider service trends, operational performance, and issue root causes to identify improvement opportunities.
• Support provider performance initiatives related to quality, access, operational efficiency, and member experience.
• Educate providers on health plan programs, administrative processes, self‑service tools, and operational requirements.
• Support value‑based care initiatives through provider engagement, education, and operational support.
• Assist with network adequacy activities, provider recruitment efforts, and regulatory initiatives as needed.
• Research and respond to provider complaints, disputes, executive escalations, and regulatory inquiries.
• Monitor provider issues through resolution and communicate status updates to internal and external stakeholders.
• Support implementation of network and operational initiatives impacting providers.
• Prepare provider‑facing materials, business summaries, issue analyses, and leadership updates.
• Ensure compliance with contractual requirements, regulatory standards, and company policies.
• Support special projects and cross‑functional initiatives as assigned.

Skills

Provider relations

Analytical skills

Cross-functional

Communication

Time management

Education

Bachelor's degree

Tools

Microsoft Excel

PowerPoint

Data analysis tools

Job description

CVS Health is seeking a Manager, Provider Relations to support the Metro New York market. This role manages provider relationships and supports provider service operations for physicians, hospitals, and health systems, collaborating with multiple internal teams to resolve issues and improve network performance.

The ideal candidate has 4+ years in healthcare operations or provider relations, strong analytical skills, and proficient Excel/PowerPoint abilities.