CVS Health

Network Relations Manager (Central Texas)

CVS Health • $60K — $132K *
Pflugerville, TX 78660In-Person
Healthcare
5 - 7 years of experience
Yesterday
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Job Overview by Ladders

Qualifications

  • 5+ years in healthcare experience
  • 3+ years in Medicaid Managed Care servicing providers
  • Knowledge of Medicaid policies and contract interpretation
  • Proficient in Microsoft Office Suite
  • Ability to travel 50-80% in defined territory
  • Reside in the Central Texas Region

Responsibilities

  • Act as primary resource for high-profile providers
  • Monitor service capabilities and collaborate cross-functionally
  • Support operational activities including database management
  • Educate Medicaid providers on contract compliance
  • Meet regularly with key providers to assess service levels
  • Facilitate provider meetings and manage agendas
  • Collaborate on provider-facing communications and workflows

Benefits

  • Opportunities for professional development and training
  • Collaborative work environment with cross-functional teams
  • Engagement with high-profile healthcare providers
Full Job Description
Position Summary

Acts as the primary resource for assigned, high profile providers and/or groups (i.e. local, individual providers, small groups/systems) to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding Medicaid policies and procedures, plan design, contract language, service, claims or compensation issues, and provider education needs.
  • Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships.
  • Monitors service capabilities and collaborate cross- functionally to ensure that the needs of constituents are met and that escalated issues related but not limited to, claims payment, contract interpretation or parameters, and accuracy of provider contract or demographic information are resolved.
  • Supports or assists with operational activities that may include, but are not limited to, database management, and contract coordination.
  • Performs credentialing support activities as needed.
  • Educates Medicaid providers as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, policies, and procedures.
  • Meets with key Providers at regular intervals to ensure service levels meet expectations.
  • Manages the development of agenda, validates materials, and facilitates external provider meetings.
  • Collaborate cross-functionally with the implementation of large provider systems, to manage cost drivers and execute specific cost initiatives to support business objectives and to identify trends and enlist assistance in problem resolution.
  • May provide guidance and training to team members.
  • Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills.
  • Collaborate with Provider Enablement & Strategy on Provider-facing communications, desktops, workflows, external trainings, reporting needs, and HUB support.
  • Facilitate internal meetings and coordinate external partner meetings to ensure effective communication and collaboration.
  • Other duties as assigned.


Required Qualifications
  • A minimum of 5 years' work experience in healthcare.
  • Minimum of 3 years' experience in Medicaid Managed Care business segment environment servicing providers with exposure to benefits and/or contract interpretation.
  • Working knowledge of business segment specific codes, products, and terminology.
  • Demonstrated expertise in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook).
  • Travel within the defined territory up to 50-80% of the time.
  • Candidates must reside in the Central Texas Region.


Preferred Qualifications
  • Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claim Lifecycle, Provider Appeals & Disputes, and Network Performance Standards.
  • Experience in Medical Terminology, CPT, ICD-10 codes, etc.


Education
  • Bachelor's degree preferred or a combination of professional work experience and education.


Anticipated Weekly Hours
40

Time Type
Full time

Pay Range

The typical pay range for this role is:

$60,300.00 - $132,600.00

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.

About CVS Health

Omnicare provides comprehensive pharmaceutical services to patients and providers across the United States. As the market-leader in professional pharmacy, related consulting and data management services for skilled nursing, assisted living and other chronic care settings, Omnicare leverages its unparalleled clinical insight into the geriatric market along with some of the industry's most innovative technological capabilities to the benefit of its long-term care customers. Omnicare also provides key commercialization services for the bio-pharmaceutical industry through its Specialty Care Group.

CVS Health Careers

Joining CVS Health presents a unique opportunity to advance your career in a company where innovation, leadership, and growth go hand in hand. As a leader in the healthcare industry, CVS Health is more than just a pharmacy. We are a team of professionals dedicated to improving lives and optimizing health outcomes.

Work You’ll Do

At CVS Health, you will be part of a culture that values diversity and inclusivity, fostering an environment where every team member’s contribution is valued. Engage in meaningful work that directly impacts lives, driving innovation in healthcare services and solutions.

Explore Job Opportunities

Whether you’re looking for a position in pharmacy services, corporate leadership, or in-store management, CVS Health offers a variety of employment opportunities that will help you harness your skills and thrive professionally. Our job opportunities span across a wide range of professional fields and geographic locations, ensuring that your career at CVS Health aligns with your professional goals and lifestyle.

Internship Programs

Kickstart your career with CVS Health through our internship programs. These opportunities are designed for ambitious students eager to develop their skills in a real-world setting. Internships at CVS Health are not only about gaining work experience but also about making meaningful contributions to our ongoing projects.

Professional Growth and Development

CVS Health is committed to the professional growth of our employees. With access to cutting-edge technology, industry-leading experts, and comprehensive diversity training, our team members are equipped to lead and innovate. We support career advancement through professional development programs, leadership training, and opportunities for networking and internal mobility.

Benefits and Culture

Our employees enjoy a range of benefits that reflect our commitment to their well-being and success. From health and wellness benefits to professional development programs, CVS Health is dedicated to ensuring our team members have the resources they need. Our inclusive culture encourages collaboration and continuous learning, making CVS Health a place where you can grow and succeed.

Join Our Team

Ready to take the next step in your career? Explore the open positions at CVS Health that match your skills and interests. We are continuously hiring and looking for passionate, curious, and solution-driven team players.

Stay Connected

Keep up to date with the latest news, career tips, and industry insights from CVS Health. Personalize your experience by subscribing to job alert emails, tailored to your preferences and professional interests. Discover the rewarding opportunities that await at CVS Health, where your career development is always a priority.

Search CVS Health Jobs

Don’t just look for a job. Look for a place where you can be a part of something bigger. Visit our careers page to find the position that’s right for you and join a team that values innovation and leadership in healthcare.

READ CAREERS BLOG

Stay ahead in your career with insights from those who know CVS Health best – our team. Learn from their experiences and get insider tips that can help you succeed in your next interview, craft a standout resume, and build a career you’re proud of at CVS Health.
Learn more about CVS Health
Size
300,000 employees
Market Cap
$122 billion
Industry
Pharmaceuticals & Biotech
Net Income
$7.1 billion
Founded
1963
5 Year Trend
+10.5%
Revenue
$268.7 billion
NASDAQ
CVS
* Ladders Estimates

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