Lead Director, Network Management

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 Summary
Aetna Better Health of Pennsylvania, a CVS Health company is committed to partnering with the Department of Community Health, state agencies, providers, and our communities to ensure access to quality healthcare. Our dedication focuses on improving health outcomes, enhancing the lives our members through an integrated whole-person and resiliency building approach. We are seeking individuals who exemplify excellence, integrity, caring, and innovation to join our team where “Heart at Work” behaviors drive our success.  You can find your next opportunity here, and we will support you every step of the way. 

procedures specifically related to long term support services. 

• Providing LTSS educational guidance for Provider Relations team.

• Manages Local Provider Engagement Team to Deploy National Engagement Model.

• Manages Local Provider Relations staff to ensure Market Leading Provider Satisfaction.

• Responsible for maintenance of Provider Engagement related policies and procedures.

• Active participation in State and regulatory audits (HSAG, NCAQ, EQRO).

• Provides service to providers by resolving problems and advising providers of new protocols, policies, and procedures.

• Recommends training materials for staff and provider network; oversees staff responsible for initial and ongoing provider in-services and provider education; develops and implements provider satisfaction surveys.

• Researches, reviews, and prepares response for all governmental, regulatory and quality assurance provider complaints; timely and continuous reconciliation of provider records; oversees Provider Access and Availability by reviewing Appointment Availability Audits conducted by staff.

• Provides support and maintenance assistance for websites, portals, directories, manuals, and dashboards; plans, coordinates, and conducts provider forums and monthly webinars; develops communications including newsletters, notifications and Fax Blasts.

• Collaborates with growth partners, as needed, to obtain crucial or required information from Providers, such as HEDIS, Credentialing, Grievance and Appeals, SIU, etc. Coordinates provider status information with member services and other internal departments.

• Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including, employment, termination, performance reviews, salary reviews, and disciplinary actions. Monitors staff performance, including weekly staff metrics; coaches and mentors’ staff on performance issues or concerns.

• Provides service to providers by resolving problems and advising providers of new protocols, policies, and procedures.

• Recommends training materials for staff and provider network; oversees staff responsible for initial and ongoing provider in-services and provider education; develops and implements provider satisfaction surveys.

• Researches, reviews, and prepares response for all governmental, regulatory and quality assurance provider complaints; timely and continuous reconciliation of provider records; oversees Provider Access and Availability by reviewing Appointment Availability Audits conducted by staff.

• Provides support and maintenance assistance for websites, portals, directories, manuals, and dashboards; plans, coordinates, and conducts provider forums and monthly webinars; develops communications including newsletters, notifications and Fax Blasts.

• Collaborates with growth partners, as needed, to obtain crucial or required information from Providers, such as HEDIS, Credentialing, Grievance and Appeals, SIU, etc. Coordinates provider status information with member services and other internal departments.

• Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including, employment, termination, performance reviews, salary reviews, and disciplinary actions. Monitors staff performance, including weekly staff metrics; coaches and mentors’ staff on performance issues or c