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.
**This person must sit within a commutable distance to the NYC office**
Position Summary
Provides strategic leadership and oversight for network management and provider relations. Develops and implements network strategies, monitors provider performance metrics, leads dispute resolution processes, and collaborates with key stakeholders to drive network growth and ensure high-quality provider relationships.
Key Role Responsibilities
Manages local provider relations staff to ensure Market Leading Provider Satisfaction scores
Escalations: Provides service to providers by resolving problems and advising providers of new protocols, policies and procedures.
Lead and manage strategic relationships with hospitals, physician groups, and ancillary providers across an assigned market or portfolio.
Conduct shadowing during provider visits on-site, virtual, and telephonic.
Drive provider performance related to quality, cost efficiency, access, and member experience metrics.
Partner closely with Network Management, Medical Management, Value-Based Care, Operations, and Finance to execute provider strategies.
Identify opportunities to improve provider engagement, resolve escalated issues, and strengthen collaboration across the provider network.
Support value-based care initiatives, including education, performance monitoring, and provider adoption of new models.
Analyze provider’s performance data and develop action plans to address gaps or risks.
Serve as a senior point of contact for complex provider concerns or operational challenges.
Work cross functionally with additional teams including claims, appeals, interoperability, and contracting to develop creative solutions and root cause issues
Ensure compliance with regulatory, contractual, and company requirements.
Required Qualifications
7-10 years of experience in healthcare operations, provider relations, managed care, or network management within a payer or provider organization.
A minimum of 2 years leadership/management experience leading staff to ensure department goals are met.
Demonstrated experience managing provider relationships, including resolving complex service issues, escalations, and provider concerns
Must have provider facing experience.
Ability to travel within the Metro NY market to the NYC office or providers offices as needed.
Preferred Qualifications
Knowledge of the local market provider community.
Knowledge of Aetna’s internal systems.
Working knowledge of Commercial and Medicare lines of business.
Education
Bachelor's degree preferred or a combination of professional work experience and education.
Pay Range
The typical pay range for this role is:
$82,940.00 - $199,144.00
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. This position also includes an award target in the company’s equity award program.
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
- 7-10 years experience in healthcare operations, provider relations, managed care, or network management within a payer or provider organization
- Minimum of 2 years leadership/management experience leading staff to meet department goals
- Demonstrated experience managing provider relationships, resolving complex service issues, escalations, and provider concerns
- Provider-facing experience
- Ability to travel within the Metro NY market to the NYC office or provider offices as needed
- Knowledge of the local market provider community
- Knowledge of Aetna's internal systems
- Working knowledge of Commercial and Medicare lines of business
- Bachelor's degree or a combination of professional work experience and education
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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.
