Medicaid Network Relations Manager, Princeton, NJ

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Position Summary

Acts as the primary resource for assigned, high profile providers or groups (i.e., local, individual providers, small groups / systems) to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding policies and procedures, plan design, contract language, service, claims or compensation issues, and provider education needs.

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.

May collaborate cross functionally on the implementation of large provider systems, to manage cost drivers and execute specific cost initiatives to support business objectives and to identify trends and enlist assistance in problem resolution.

Conduct standard provider recruitment, contracting, or re-contracting activities and assist with more complex contracting and discussions as needed by business segment.

May provide guidance and training to less experienced team members

Required Qualifications

Approximately 25% travel within a 50+ / - mile radius to provider and hospital locations within New Jersey assigned territory

Minimum 3+ years' experience in business segment environment servicing providers with exposure to benefits and / or contract interpretation.

Minimum 3+ years' experience with business segment specific policy, benefits, plan design and language

Medicaid Managed Care

Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills

Preferred Qualifications

Working knowledge of business segment specific codes, products, and terminology.

Education

Bachelor's degree preferred / specialized training / relevant professional qualification

Pay Range

The typical pay range for this role is :

$63,300.00 - $139,200.00

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.