Senior Manager, Provider Relations (Pennsylvania)

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Provides strategic leadership and oversight for network management and provider relations. Develops and implements network strategies, monitors provider performance metrics, leads dispute resolution processes, and collaborates with key stakeholders to drive network growth and ensure high-quality provider relationships.

• ​Manages local provider relations staff to ensure Market Leading Provider Satisfaction scores

• 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.

• Assist with maintaining 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.

• Conference participation, as needed.

• 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.  

• Demonstrated ability to influence and collaboration with internal and external partners via strong written and verbal communications.  

• Other duties as assigned.

Required Qualifications

• Must reside in Pennsylvania. (State specific)

• A minimum of 7 years work experience in healthcare.

• Must have working knowledge of Medicaid.

• A minimum of 2 years leadership/management experience leading / managing staff to ensure department goals are met. 

• Must have provider facing experience.

• Travel within Market as needed.

Preferred Qualifications

• Demonstrated ability to identify and manage initiatives that improve total medical cost and quality.  

• Experience in managed care and provider engagement.

• Knowledge of the local market provider community.

Education

• Bachelor's degree preferred or a combination of professional work experience and education.

Pay Range

The typical pay range for this role is:

$75,400.00 - $165,954.00

This 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.  This position also includes an award target in the company’s equity award program. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

• Benefit solutions that address the d