Provider Network Relationship Manager

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.

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: Candidates must reside in Ohio

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.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$54,300.00 - $119,340.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job gr