Strategic Behavioral Health Provider Relations Lead

CVS Health Corporation; Broussard (LA); On-site; USD 54,000 - 119,000; Full time

Benefits offered by this job

Comprehensive benefits

Bonus eligibility

Paid time off

Retirement savings options

Job summary

CVS Health Corporation seeks an experienced Provider Relations Specialist to manage high-profile Medicaid providers and groups. You will address complex issues around policies, contracts, service, claims or compensation, and provider education needs, ensuring timely, compliant resolutions.

You will collaborate with cross-functional teams, conduct credentialing support, and educate providers on contract policies and design. This role requires travel up to 50-80% and Louisiana residency.

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.
• Minimum of 2 years' experience working with providers and contracts in the behavioral health sector.
• Working knowledge of codes, products, and terminology relevant to the business segment.
• Proficiency in Microsoft Office Suite, including Excel, Word, and PowerPoint.

Responsibilities

• Optimizes interactions with assigned providers and internal partners to build productive relationships.
• Monitors service capabilities and collaborates cross-functionally to meet constituent needs and resolve issues related to claims, contracts or provider data.
• Supports operational activities such as database management and contract coordination.
• Performs credentialing support activities as needed.
• Educates Medicaid providers to ensure compliance with contract policies, plan design, and procedures.
• Meets with key providers regularly to ensure service levels meet expectations.
• Manages meeting agendas, materials, and external provider meetings.
• Collaborates with implementation teams on large provider systems to manage cost drivers and identify trends.
• Provides guidance and training to less experienced team members.
• Communicates with Provider Enablement & Strategy on provider communications and workflows.

Skills

Healthcare experience

Medicaid knowledge

Contract interpretation

Communication skills

Travel readiness

Education

Bachelor's degree preferred

Tools

Microsoft Excel

Microsoft Word

PowerPoint

Job description

CVS Health Corporation seeks an experienced Provider Relations Specialist to manage high-profile Medicaid providers and groups. You will address complex issues around policies, contracts, service, claims or compensation, and provider education needs, ensuring timely, compliant resolutions.

You will collaborate with cross-functional teams, conduct credentialing support, and educate providers on contract policies and design. This role requires travel up to 50-80% and Louisiana residency.