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.
Job Summary:
- Acts as the primary liaison for assigned geography of integrated providers, (i.e. market/regional/national, large group) to establish, oversee, and maintain provider risk management and positive relationships and supports high value initiative activities.
- *Conducts provider education, ensures contract compliance, provider communication, claims research and assists with resolution
- *Implementation of internal and external solutions to achieve provider satisfaction, cost targets, network growth, and efficiency targets.
Required Qualifications
- Must be experienced in working with all reimbursement payment methodologies
- 3-5 years of provider relations and/or network management experience required
- Experienced in working with large provider groups, capitated agreements, behavioral health provider
- Must have excellent written, oral, and interpersonal communication skills
- Computer literate in Word, Excel, Microsoft Office
- Must be flexible and able to handle a highly, fast-paced environment
- Must reside in North or South Carolina
Preferred Qualifications
- Knowledge of Medicare programs
- Knowledge of various Behavioral Health and Commercial payment methodologies
- Medical claims processing knowledge
- Experience working within Provider Databases (i.e. EPDB) a plus
- Critical thinking, problem resolution and ability to work independently
- Excellent time management skills
- Must be flexible and able to handle a highly, fast-paced environment
Education
- Associate Degree or equivalent combination of education and experience
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$46,988.00 - $91,800.00This 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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Skills Required
- Experience with all reimbursement payment methodologies
- 3-5 years provider relations and/or network management experience
- Experience working with large provider groups, capitated agreements, behavioral health providers
- Excellent written, oral, and interpersonal communication skills
- Computer literate in Word, Excel, Microsoft Office
- Flexible and able to handle a highly fast-paced environment
- Must reside in North or South Carolina
- Associate Degree or equivalent combination of education and experience
- Knowledge of Medicare programs
- Knowledge of Behavioral Health and Commercial payment methodologies
- Medical claims processing knowledge
- Experience working within Provider Databases (e.g., EPDB)
- Critical thinking, problem resolution and ability to work independently
- Excellent time management skills
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
