• Job Description

  Req#: R0556199

  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
  The Network Relations Sr Analyst supports our Medicaid Provider Experience programs to maintain provider risk management and positive relationships supporting high value initiative activities with our Provider network. The Network Relations Sr Analyst will assist in driving coordination of internal and external solutions to achieve Best-in-Class provider satisfaction, affordability and quality improvements as set by each Medicaid Health Plan.

  • Deploy and support the Medicaid Provider Engagement program including onsite meetings at Aetna offices as required
  • Reviews, learns and participates with operations teams regarding policy and procedures related to claims/providers.
  • Assist with the monitoring of executed provider contracts to ensure Network Access meets State requirements
  • Coordinates provider information with Provider Data Services including Member Services and other internal departments as requested as Provider Demographics are updated
  • Supports providers by resolving problems and advising providers of new protocols, policies, and procedures
  • Deliver training materials for staff and provider network. Participates as need for initial and ongoing provider in-services and provider education.
  • Participates, when requested, in Grievance and Appeals meetings, and/or assists with tracking and trending provider grievances,
  • Assists as requested for responses for all governmental, regulatory and quality assurance provider complaints; timely and continuous reconciliation of provider records; oversees Provider Access and Availability by reviewing Appointment Availability Audits conducted by staff
  • Provides support and maintenance assistance for websites, portals, directories, manuals, and dashboards; plans, coordinates, and conducts provider forums and monthly webinars; develops communications including newsletters
  • Provides assistance and support to other departments, as needed, to obtain crucial or required information from Providers, such as HEDIS, Credentialing, Grievance and Appeals, SIU, etc. Coordinates provider status information with member services and other internal department
  • Promotes and educate providers on cultural competency

  
  Required Qualifications

  • Minimum of 3 to 5 years’ experience in Provider Relations; experience in Medicaid servicing or managing non-standard relationships with providers with exposure to benefit plan design and/or contract interpretation
  • Excellent interpersonal skills and the ability to work with others at all levels
  • Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and Network Performance Standards
  • Excellent problem-solving skills
  • Strong communication skills
  • Candidates are to reside within applicable state with ability to travel as needed to provider sites and Aetna office locations as required

  
  Education

  Bachelor’s degree or an equivalent combination of formal education and experience

  Anticipated Weekly Hours

  40

  Time Type

  Full time

  Pay Range

  The typical pay range for this role is:

  $46,988.00 - $122,400.00

  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 https://jobs.cvshealth.com/us/en/benefits

  We anticipate the application window for this opening will close on: 07/02/2025

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

• About the company

  At CVS Health, we share a clear purpose: helping people on their path to better health. Through our health services, plans and community pharmacists, we’re pioneering a bold new approach to total health. Making quality care more affordable, accessible, simple and seamless, to not only help people get well, but help them stay well in body, mind and spirit.

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