Medicaid Network Relations Manager, Princeton, NJ

at  CVS Health

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

Acts as the primary resource for assigned, high profile providers 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 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 collaborates 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 providers as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, policies, and procedures.
• Meets with key providers periodically to ensure service levels are meeting expectations.
• Manages the development of agenda, validates materials, and facilitates external provider meetings.
• May collaborate cross functionally on 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.
• Conduct standard provider recruitment, contracting, or re-contracting activities and assist with more complex contracting and discussions as needed by business segment.
• May provide guidance and training to less experienced team members

Required Qualifications

• Approximately 25% travel within a 50+/- mile radius to provider and hospital locations within New Jersey assigned territory
• Minimum 3+ years’ experience in business segment environment servicing providers with exposure to benefits and/or contract interpretation.
• Minimum 3+ years’ experience with business segment specific policy, benefits, plan design and language

PREFERRED QUALIFICATIONS

• Prefer experience in Medicaid Managed Care
• Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills with a passion for constituent support
• Working knowledge of business segment specific codes, products, and terminology

EDUCATION

Bachelor’s degree preferred/specialized training/relevant professional qualification

Please refer the Job description for details