Manager - Provider Network Relations

At CVS Health, were building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nations 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.

POSITION SUMMARY

This position is fully dedicated to GLOBAL VIP CLIENT. The ideal candidate will assist the Senior Network Manager in managing competitive and complex contractual relationships with TPAs and business partners in Africa,. This role supports the international network, medical cost management, and overall claim / customer service experience. The candidate will provide concierge-level service to GLOBAL VIP CLIENT members by ensuring timely network access and proactive management of network relationships for seamless direct settlement access. Additionally, the candidate will assist with day-to-day network operations and act as a liaison between external vendors and internal team members.

Preference is for this person to reside within the Eastern Time Zone

JOB RESPONSIBILITIES

• Play a critical role via assisting in setting up 3 -5 direct TPAs setup for GLOBAL VIP CLIENT in next 12 months time frame.
• Assist Sr. Network manager to manage assigned TPAs via managing day to day operational issues with TPA for GLOBAL VIP CLIENT and work on a resolution of such issues.
• Primary responsible for driving GLOBAL VIP CLIENT nominations and work with TPA to add those providers In-Network. Manage overall responsibilities of provider nomination process for GLOBAL VIP CLIENT.
• Manage network contracting with assigned TPA(s) including addition & suspension of provider.
• Assist with Third Party Risk Governance process for your assigned TPA(s).Oversee, audit, and process primary TPA invoices; review and address disputed items as necessary.
• If any, support manage contracting / maintenance of individual direct providers
• Manage escalated Issues GOP, Proof of Payment, Provider suspension, Immediate client Issue resolution with TPA & Provider
• If a GOP is issued but the facility does not accept it, contact the TPA or Provider immediately for a swift resolution.
• Assist Network manager in ensuring service level adherence (GOP TAT, eligibility processing, claim TAT, reconciliation TAT, fee invoicing etc)
• Ensure TPA networks are timely reviewed and uploaded on internal Aetna systems.
• Ensure TPA guides, country guides and other internal materials are timely updated and up to date.
• Ensuring streamline GLOBAL VIP CLIENT experience at each country level. Work with account management and TPA to resolve ongoing operational issues.
• End to end ownership of operational issues originating from assigned TPAs and work towards swift resolutions.
• Serve as a subject matter expert to assist the internal GLOBAL VIP CLIENT account management team with network and TPA questions or inquiries. Provide support to peers and colleagues working on GLOBAL VIP CLIENT business.

REQUIRED QUALIFICATIONS

PREFERRED QUALIFICATIONS

EDUCATION

Bachelor's degree or equivalent experience.

ADDITIONAL JOB INFORMATION

Opportunity to work in a fast pace, growing and exciting international arena supporting key Aetna International clients and managing critical Aetna vendors.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is :

$54,300.00 - $159,120.00

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.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include :

Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan .

No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit

We anticipate the application window for this opening will close on : 09 / 30 / 2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex / gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

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