Network Relations Manager

Company	CVS Health
Location	Miami Beach, FL, USA, Homestead, FL, USA, Miami, FL, USA, Doral, FL, USA, Aventura, FL, USA, Miami Lakes, FL, USA, Coral Gables, FL, USA
Salary	$54300 – $119340
Type	Full-Time
Degrees	Bachelor’s
Experience Level	Mid Level, Senior

3 year’s experience in business segment environment servicing providers with exposure to benefits and/or contract interpretation.
3-5 year’s experience with business segment specific policy, benefits plan design and language.
Strong verbal and written communication, interpersonal problem resolution and critical thinking skills.
Working knowledge of business segment specific codes, products and terminology.
Bilingual (English and Spanish) preferred.
Bachelor’s degree or an equivalent combination of formal education and experience.

Research and handle contract related issues (ability to research and deep dive).
Claims research related to provider set up issues, payment resolutions and coordinate with Claims SME
Provider visits onsite, virtual, and telephonic
Facilitate JOCs and webinars
Provider orientations/visits
Provider training
State projects
Create and manage provider-facing communications: newsletters, website updates, provider manual, email/fax blast
Collaborates w/ Quality Management and VBS team to assist w/ facilitation of provider request to enhance quality metrics and relationship building
Coordinate with Network Management to issue provider CAP
Monitor Grievances according NCQA standards categories (3 grievances per QTR), including progressive corrective action
Monitor provider performance in accordance with provider responsibilities policy, contract, state and federal requirements
Attend Plan committee meetings, as needed
Recredentialing non-responder follow up
Communicate growth partner response to providers
Manage IPA provider rosters, submit to MPOS
Document visits/encounters in the appropriate systems (CRM)
Travel within Market
Other duties as assigned

No preferred qualifications provided.