Description
Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. *Position Summary* The Senior Manager of Provider Relations manages a team of Provider/Network Relations representatives (*approximately 4*) and reports to the local Lead Director. Oversees the maintenance of working relationships with the existing network and assists in the recruitment of new providers. Develops processes to collect and maintain accurate and current provider databases relating to provider facilities and provider information. Assists in the development of policies and procedures. Manage the development of contracts and agreements with providers and delivery systems in conjunction with network. Engages to ensure compliance and regulatory requirements are met. Develops and implements training programs and educational materials for providers as well as internal staff. Responsible for other duties as assigned and required by the business and position. * Manages local Provider Experience team to deploy national engagement model. * Manages local Provider Relations staff to ensure Market Leading Provider Satisfaction scores. * Co-facilitates provider Advisory Group and JOC meetings to work with management to implement changes via coordination of Quality Management; to develop appropriate clinical measure improvements and implement those measures in the provider community. * Escalations: Provides service to providers by resolving problems and advising providers of new protocols, policies, and procedures. * Assists in creation of reports, attends, and presents at Plan committee meetings (Grievance, SIC, etc.) * Coordinates provider information with member services and other internal departments as requested. * Conducts shadowing during on-site, virtual, and telephonic provider visits. * Monitors after-visit provider surveys. * Provides service to providers by resolving problems and advising providers of new protocols, policies, and procedures. * Active participation in State and regulatory audits * Travels within Market * Conference participation, as needed * Other duties as assigned *Required Qualifications* * Must be commutable distance to office location listed * Minimum of 3 years recent Managed Care experience in Provider Relations, Network Operations, and/or Network Management * Experience with Employee Supervision and leading teams * Medicaid Network experience * Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and Network Performance Standards * Excellent interpersonal skills and the ability to work with others at all levels * Excellent analytical and problem-solving skills * Strong communication, negotiation, and presentation skills *Preferred Qualifications* Proficient in Microsoft products *Education* Bachelor's degree preferred/specialized training/relevant professional qualification. *Pay Range* The typical pay range for this role is: $86,700.00 - $190,700.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company's equity award program. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit [jobs.CVSHealth.com/benefits](https://jobs.cvshealth.com/benefits) We anticipate the application window for this opening will close on: 05/19/2024
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