Manager, Medicaid Provider Data Services

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 SummaryProvides strategic leadership and oversight for network management and provider relations. Develops and implements network strategies, manages provider contracts and negotiations, monitors provider performance metrics, leads dispute resolution processes, and collaborates with key stakeholders to drive network growth and ensure high-quality provider relationships.What you will do• Coordinates the provider data management process by collecting, organizing, and maintaining accurate and up-to-date provider information, including credentials, contact details, specialties, affiliations, and insurance network participation.• Develops tactical and operational plans to establish and enforce data standards, processes, and quality control measures to ensure that provider information is accurate, consistent, and compliant with industry regulations and organizational standards.• Oversees the maintenance of the healthcare company's provider network by updating provider directories, network databases, and online platforms to reflect changes in provider information, such as new additions, terminations, address updates, and other modifications.• Collaborates with the provider enrollment team to ensure timely and accurate processing of applications, verification of credentials, and enrollment into the organization's networks or panels.• Ensures compliance with regulatory requirements related to provider data, as outlined by government agencies, accrediting bodies, or health insurance regulations.• Documents provider reports and results from metrics related to provider data quality, network utilization, and performance indicators.• Identifies opportunities for process improvement within provider data services by streamlining workflows, and implementing automation for technology solutions to enhance data management efficiency and accuracy.• Manages team performance through regular, timely feedback as well as the formal performance review process to ensure delivery of exceptional services and engagement, motivation, and team development.• Coordinates vendor relationships, contract negotiation, and service level agreements (SLAs) to ensure efficient and accurate provider data servicesRequired Qualifications• 5-7 years work experience• Adept at execution and delivery (planning, delivering, and supporting) skills• Adept at business intelligence• Adept at problem solving and decision making skills• Adept at collaboration and teamwork• Adept at growth mindset (agility and developing yourself and others) skills• A minimum of 1 year managing a team.Preferred Qualifications• Medicaid experience is strongly preferred.• Knowledge of QNXT application.Education• Bachelor's degree or equivalent professional work experience.Pay RangeThe typical pay range for this role is:$54,300.00 - $119,340.00This 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.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/benefitsWe anticipate the application window for this opening will close on: 09/30/2024Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.