Manager, Network Relations
Job
4004 Aetna Medicaid Administrators
Montville, NJ (In Person)
$106,095 Salary, Full-Time
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Job Description
We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger
- helping to simplify health care one person, one family and one community at a time.
- Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships.
- Monitors service capabilities and collaborates cross
- functionally to ensure that the needs of constituents are met and that escalated issues related but not limited to, claims payment, contract interpretation or parameters, and accuracy of provider contract or demographic information are resolved.
- Supports or assists with operational activities that may include, but are not limited to, database management, and contract coordination.
- Performs credentialing support activities as needed.
- Educates providers as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, 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.
- Will collaborate cross-functionally on the implementation of products, contracts or provider demographic updates
- Sought out as a subject matter expert within the team for progress, program overviews, and state-specific contractual requirements
- Responsible for onboarding new staff, facilitating on-going training
- Position will attend and interact with external/state facilitated calls, working sessions and Joint Operating Committees Required Qualifications Strong knowledge of business segment specific codes, products, and terminology 5+ years' experience with business segment specific policy, benefits, plan design and language Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills 5+ years in external-facing customer service working with providers Preferred Qualifications 3+ years' experience in business segment environment servicing providers with exposure to benefits and/or contract interpretation Education Bachelor's Degree or equivalent experience Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $66,330.
- $145,860.
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