Manager, Network Relations

This individual will work independently and be accountable to handle a variety of activities including educating providers on our line of business, engaging in contract and claim review, facilitating detailed claims reconciliations as issues arise, analyzing complex provider reporting, negotiating one time letters of agreement, presenting to external clients overview of our network capabilities.

The position is hybrid and being hired either out of New York City, NY or Fort Lauderdale, FL area; this means the individual will go into the office regularly either to the New York City, NY or Plantation, FL office. There will be some local ad hoc domestic travel to large health systems based on the individual's location.Position Responsibilities

Establishes relationships with network providers, fostering open communication and collaboration to ensure a strong network partnership.

Addresses and resolves escalated issues and concerns raised by network providers, demonstrating a proactive and customer-centric approach to problem-solving.
Collaborates to negotiate and establish contractual terms and conditions with network providers, ensuring alignment with organizational goals and objectives.

Collaborates with cross-functional teams, such as finance, operations, and customer service, to ensure effective coordination and alignment of network-related activities and initiatives.
Conducts regular meetings and performance reviews with network providers to review performance metrics, address concerns, and identify opportunities for improvement.
Stays updated on industry trends, regulatory changes, and market dynamics that may impact network provider relationships, and proactively communicates relevant information to internal stakeholders.

Required Qualifications

• 2-3 years claims processing experience to support provider specific questions, reconciliations, and understand claims rules.
• 2-3 years contract building
• 2-3 years provider relations
• Excellent internal and external communication stills.
• Handling VVIP client expectations in timely and professional manner.
• Experience in internal systems to update and review provider insurance contracts.
• Ability to work hybrid 2 to 3 days a week in either the New York 101 Park Ave. or the Plantation 261 University Dr. Florida. office.

Preferred Qualifications

• Aetna specific medical claim processing experience.
• Aetna specific provider contract setup experience.

Education

• Bachelor's degree preferred/specialized training/relevant professional qualification.
• Prior Relevant Work Experience 5-7 years

Anticipated Weekly Hours
40Time Type
Full timePay Range

The typical pay range for this role is:$60,300.00 - $159,120.00This 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 peopleWe 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/benefitsWe anticipate the application window for this opening will close on: 05/25/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.