Provider Relations Senior Manager, Medicaid-Must reside in IL

CVS Health Provider Experience 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.

Position Summary Provides strategic leadership and oversight for the provider experience staff. Develop long-term relationships with network providers and IL Associations by enhancing interactions between providers and the health plan, ensuring seamless communication, operational efficiency, and overall enhancing the provider experience. Drives the implementation of internal and external solutions to achieve provider satisfaction, cost targets, utilization / performance, network growth, and efficiency targets. Manages and oversees compliance within our network responsibilities as provided within the state Medicaid contractual requirements. This position holds a variety of functions for provider experience to ensure successful provider relationship, network performance including clinical, and affordability targeted improvements as identified and overall staffing support.

Duties :

• Provider Engagement & Relationship Management : Strengthen partnerships with network providers to improve their experience and satisfaction.
• Process Improvement : Work with Sr. Managers and Director to develop and implement strategies to streamline, policies, procedures, provider interactions / trainings and optimize workflows.
• Data & Insights Utilization : Leverage analytics to identify trends, address escalated provider concerns, and enhance service delivery.
• Cross functional Team Collaboration : Work closely with internal teams to align provider experience initiatives with organizational goals.
• Stakeholder Collaboration : Participate in HFS, IAMHP, and IL Associations Meetings / Conferences.
• Training & Support : Ensure providers have access to necessary resources, training, and support for compliance and operational success.
• Research, review, and prepare responses for all governmental, regulatory and quality assurance provider complaints, timely and continuous reconciliation of provider records.
• Provides support and maintenance assistance for websites, portals, directories, provider manuals, and dashboards. Plans, coordinates, and conducts provider forums and monthly webinars; develops communications including newsletters, notifications, and Fax Blasts.
• Issue Resolution : Address provider challenges proactively and implement solutions to improve their experience.
• Compliance : Ensure providers adhere to regulatory requirements and network policies.
• Strategic Oversight : Lead initiatives to improve provider satisfaction and streamline operations.
• Team Leadership : Manage provider relations staff and oversee day-to-day operations.

Required Qualifications :

Education : Bachelor's degree preferred / specialized training / relevant professional qualifications

Pay Range : The typical pay range for this role is : $82,940.00 - $182,549.00

Great benefits for great people :

We anticipate the application window for this opening will close on : 12 / 01 / 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.