Provider Relations Manager (Michigan)

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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

Join the Medicaid Provider Relations team as Provider Relations Manager, where you will act as the primary resource for assigned, high profile providers and groups (i.

e. local, individual providers, small groups / systems) to establish, oversee, and maintain positive relationships by assisting with complex issues regarding Medicaid policies and procedures, plan design, contract language, service, claims or compensation issues, and provider education needs.

Additionally, you will :

Research and handle contract related issues (ability to research and deep dive).

Claims research related to provider set up issues, payment resolutions and coordinate with Claims SME

Provider visits onsite, virtual, and telephonic

Facilitate JOCs and webinars

Provider orientations / visits

Provider training

State projects

Create and manage provider-facing communications : newsletters, website updates, provider manual, email / fax blast

Collaborates w / Quality Management and VBS team to assist w / facilitation of provider request to enhance quality metrics and relationship building

Coordinate with Network Management to issue provider CAP

Monitor Grievances according NCQA standards categories (3 grievances per QTR), including progressive corrective action

Monitor provider performance in accordance with provider responsibilities policy, contract, state and federal requirements

Attend Plan committee meetings, as needed

Re-credentialing non-responder follow up

Communicate growth partner response to providers

Manage IPA provider rosters, submit to MPOS

Document visits / encounters in the appropriate systems (CRM)

Travel within Market (at least 50%)

This individual will not have direct reports in this role.

Required Qualifications

3+ years' experience in Managed Care / health insurance business segment environment, servicing providers with exposure to benefits or contract interpretation

3+ years' of working knowledge of business segment specific codes, products, and terminology

3 years of claims experience (professional and institutional).

Must reside in Michigan and have the ability to travel at least 50% in the assigned market.

Preferred Qualifications

Familiarity with Medicaid operations and provider contracting

Strong verbal and written communication, interpersonal problem resolution and critical thinking skills with proven ability to influence and collaborate with providers at all levels

Education

Bachelor's Degree or equivalent combination of education and experience

Pay Range

The typical pay range for this role is :

$60,300.00 - $132,600.00

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.

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.