Provider Relations Manager (Michigan Medicaid)
CVS Health, Detroit, MI, United States
Position Summary
This is an individual contributor role.
Acts as the primary resource for assigned, high profile providers and/or groups to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding Medicaid policies and procedures, plan design, contract language, service, claims or compensation and provider education needs.
Responsibilities
Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships.
Monitors service capabilities and collaborates cross‑functionally to ensure that the needs of constituents are met and that escalated issues, such as claims payment, contract interpretation or parameters, and accuracy of provider contract or demographic information are resolved.
Supports or assists with operational activities that may include database management and contract coordination.
Performs credentialing support activities as needed.
Educates Medicaid providers to ensure compliance with contract policies and parameters, plan design, compensation process, technology, policies, and procedures.
Meets with key providers at regular intervals to ensure service levels meet expectations.
Manages the development of agenda, validates materials, and facilitates external provider meetings.
Collaborates cross‑functionally with the implementation of large provider systems to manage cost drivers and execute specific cost initiatives to support business objectives and identify trends and enlist assistance in problem resolution.
May provide guidance and training to less experienced team members.
Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills.
Collaborates with Provider Enablement & Strategy on provider‑facing communications, desktops, workflows, external trainings, reporting needs, and HUB support.
Other duties as assigned.
Required Qualifications
A minimum of 5 years work experience in healthcare.
Minimum of 3 years experience in the Medicaid Managed Care business segment environment servicing providers with exposure to benefits and or contract interpretation.
Working knowledge of business segment specific codes, products, and terminology.
Travel within the defined territory up to 50‑80% of the time.
Candidates must reside in the state of Michigan.
Preferred Qualifications
Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claim Lifecycle, Provider Appeals & Disputes, and Network Performance Standards.
Experience with medical terminology, including CPT and ICD‑10 coding.
Demonstrated experience delivering clear, engaging presentations to diverse audiences, including leadership, stakeholders, and external partners.
Knowledge of claims management processes and workflows.
Proficiency in Salesforce, QNXT, and the Microsoft Office Suite.
Education
Bachelor's degree preferred or a combination of professional work experience and education.
Compensation Anticipated Weekly Hours: 40
Time Type: Full time
Pay Range: $60,300.00 – $132,600.00
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 experience, education, geography and other factors. This position is eligible for CVS Health bonus, commission or short‑term incentive program in addition to the base pay range.
Benefits 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. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. Benefits include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Equal Opportunity CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran — committed to diversity in the workplace.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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Acts as the primary resource for assigned, high profile providers and/or groups to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding Medicaid policies and procedures, plan design, contract language, service, claims or compensation and provider education needs.
Responsibilities
Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships.
Monitors service capabilities and collaborates cross‑functionally to ensure that the needs of constituents are met and that escalated issues, such as claims payment, contract interpretation or parameters, and accuracy of provider contract or demographic information are resolved.
Supports or assists with operational activities that may include database management and contract coordination.
Performs credentialing support activities as needed.
Educates Medicaid providers to ensure compliance with contract policies and parameters, plan design, compensation process, technology, policies, and procedures.
Meets with key providers at regular intervals to ensure service levels meet expectations.
Manages the development of agenda, validates materials, and facilitates external provider meetings.
Collaborates cross‑functionally with the implementation of large provider systems to manage cost drivers and execute specific cost initiatives to support business objectives and identify trends and enlist assistance in problem resolution.
May provide guidance and training to less experienced team members.
Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills.
Collaborates with Provider Enablement & Strategy on provider‑facing communications, desktops, workflows, external trainings, reporting needs, and HUB support.
Other duties as assigned.
Required Qualifications
A minimum of 5 years work experience in healthcare.
Minimum of 3 years experience in the Medicaid Managed Care business segment environment servicing providers with exposure to benefits and or contract interpretation.
Working knowledge of business segment specific codes, products, and terminology.
Travel within the defined territory up to 50‑80% of the time.
Candidates must reside in the state of Michigan.
Preferred Qualifications
Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claim Lifecycle, Provider Appeals & Disputes, and Network Performance Standards.
Experience with medical terminology, including CPT and ICD‑10 coding.
Demonstrated experience delivering clear, engaging presentations to diverse audiences, including leadership, stakeholders, and external partners.
Knowledge of claims management processes and workflows.
Proficiency in Salesforce, QNXT, and the Microsoft Office Suite.
Education
Bachelor's degree preferred or a combination of professional work experience and education.
Compensation Anticipated Weekly Hours: 40
Time Type: Full time
Pay Range: $60,300.00 – $132,600.00
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 experience, education, geography and other factors. This position is eligible for CVS Health bonus, commission or short‑term incentive program in addition to the base pay range.
Benefits 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. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. Benefits include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Equal Opportunity CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran — committed to diversity in the workplace.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
#J-18808-Ljbffr