Manages a team of Provider/ Network Relations supervisors and/or representatives. 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.
May provide network development, maintenance, and refinement activities and strategies in support of cross-market network management unit. Assists with the design, development, management, and or implementation of strategic network configurations and integration activities.
May optimize interaction with assigned providers and internal business partners to manage relationships to ensure provider needs are met.
Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.
Required to communicate w/internal/external parties by phone/in person; may require travel to offsite locations.
**Must live in the Overland Park, KS area. This is an office-based position. However, frequent Work From Home opportunities will be available. **
Experience with Medicaid managed care.
Minimum of 5 to 7 years recent and related experience in healthcare.
Minimum 2-3 years in a supervisory position.
Knowledge of claims, ICD-9, ICD-10 and CPT codes.
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.
3-5 years in a managed care setting, preferably at a health plan.
5+ years recent and related experience in Provider Relations.
Bachelor's degree or equivalent experience
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.