Texas Medicaid Provider Engagement Senior Manager

at  CVS Health

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POSITION SUMMARY

The Medicaid Sr. Manager, Provider Engagement manages and oversees compliance with our Provider Engagement responsibilities.

• Manages local PR 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 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.
• Assist in creation of reports, attend, and present at Plan committee meetings (Grievance, SIC, etc.)
• Coordinate’s provider information with member services and other internal departments as requested.
• Conduct shadowing during provider visits on-site, virtual, telephonic
• Monitor after-visit provider survey
• Maintain local policies and procedures
• Provides service to providers by resolving problems and advising providers of new protocols, policies, and procedures.
• Active participation in State and regulatory audits
• Travel within Market as needed
• Conference participation, as needed
• Other duties as assigned

REQUIRED QUALIFICATIONS

• Must reside in TX, preferably Harris, Dallas, Hidalgo, Travis Counties. Central TX is a desired location as well
• Minimum of 5+ years recent Managed Care experience in Provider Relations & Employee Supervision with 2 - 3 years Medicaid Network experience
• Experience leading / managing staff to ensure department goals are met.
• Medicaid experience including knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and Network Performance Standards
• Excellent analytical and problem-solving skills
• Travel within market as needed

PREFERRED QUALIFICATIONS:

• Strong communication, critical thinking, problem resolution, interpersonal skills, organizational and time management skills.
• Team player with proven ability to develop strong working relationships within a fast-paced, matrix organization.
• Proficient in Microsoft productsDemonstrated ability to influence and collaboration with internal and external partners via strong written and verbal communications.
• Demonstrated ability to identify and manage initiatives that improve total medical cost and quality.

EDUCATION:

Bachelor’s degree in a closely-related field or an equivalent combination of formal education and recent, related experience.

• Manages local PR 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 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.
• Assist in creation of reports, attend, and present at Plan committee meetings (Grievance, SIC, etc.)
• Coordinate’s provider information with member services and other internal departments as requested.
• Conduct shadowing during provider visits on-site, virtual, telephonic
• Monitor after-visit provider survey
• Maintain local policies and procedures
• Provides service to providers by resolving problems and advising providers of new protocols, policies, and procedures.
• Active participation in State and regulatory audits
• Travel within Market as needed
• Conference participation, as needed
• Other duties as assigne