Provider Network Relationship Manager

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.As part of the bold vision to deliver the “Next Generation” of managed care in Ohio Medicaid, Ohio RISE will help struggling children and their families by focusing on the individual with strong coordination and partnership among MCOs, vendors, and ODM to support specialization in addressing critical needs. The OhioRISE Program is designed to provide comprehensive and highly coordinated behavioral health services for children with serious/complex behavioral health needs involved in, or at risk for involvement in, multiple child-serving systems.Position Summary:This position assesses overall network composition and potential provider partners in order to identify and service partnerships that will advance and differentiate the OhioRISE Network. This executes, services and may negotiate contracts with local market providers in accordance with company and program standards to enhance provider networks and exceed accessibility, quality, and financial goals and cost initiatives. Must reside in Ohio.Fundamental Components:• Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships and partners on the development of business strategy and programs to support the operational plans.• Collaborates cross-functionally to ensure resolution of escalated issues or projects for assigned provider systems and monitors performance and adherence to scorecards and payout schedules based on established quality, growth, and clinical measures.• Educates internal and external parties as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, performance measurement techniques, 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, data reports and execute specific cost initiatives to support business objectives and to identify trends and enlist assistance in problem resolution.• May be responsible for provider recruitment, contracting, or re-contracting activities, or may assist and support more complex contracting and discussions.• Drives provider engagement, and may recruit providers, as needed to ensure attainment of network expansion and adequacy targets.• Assists with the design, development, management, and or implementation of strategic network configurations and integration activities.• Serves as SME for less experienced team members and internal partners.Required Qualifications:• In depth knowledge of behavioral health market and strong experience building and maintaining relationships with Behavioral Health providers.• 5+ years related experience in managed care and comprehensive level of influencing skills with successful track record negotiating and/or servicing contracts with individual or complex provider systems or groups, preferably in Behavioral Health.• Strong communication, critical thinking, problem resolution and interpersonal skills.• Understands the regulatory environment and ensures contractual compliance with state requirements.• Ability to travel in-state as needed. Must have reliable transportation, valid/active driver's license, and proof of vehicle insurance.• Computer literate; proficiency with MS Office Suite applications.Preferred Qualifications:• In depth knowledge of Ohio managed care market, Medicaid preferred.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 Benefits | CVS HealthWe anticipate the application window for this opening will close on: 11/23/2024Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.