Contractual Qnxt Jobs (NOW HIRING)

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 ourselvesaccountable 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.

Position Summary

Acts as the primary resource for an internal team who respond to inquiries via a mailbox regarding Medicaid policies and procedures, plan design, contract language, service, claims or compensation issues, and provider education needs.

• Monitors service capabilities and collaborate cross-functionally to ensure that the needs of constituents aremet and that escalated issues related but not limited to,claims payment, contract interpretation or parameters,and accuracy of provider contract or demographicinformation are resolved.
• Supports or assists with operational activities that mayinclude, but are not limited to, database management,and contract coordination, Tin Mapping/Certification
• Performs credentialing support activities as needed.
• Collaborate cross-functionally with theimplementation of large provider systems, to managecost drivers and execute specific cost initiatives tosupport business objectives and to identify trends andenlist assistance in problem resolution.
• May provide guidance and training to less experiencedteam members.
• Strong verbal and written communication, interpersonal,problem resolution and critical thinking skills.
• Collaborate with Provider Enablement & Strategy on Provider-facing communications, desktops, workflows, external trainings, reporting needs, and HUB support.
• Ensures all turnaround times are met according to the state contractual agreement with Aetna Better Health of Oklahoma
• Other duties as assigned.

Required Qualifications

• 5+ years' work experience in a leadership role
• Experience working in a Medicaid plan
• Knowledge of QNXT, Quickbase, and WFM (Workflow Manager tool)
• Strong knowledge of mapping and certification of providers
• Must reside in Oklahoma

Preferred Qualifications

• Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claim Lifecycle, Provider Appeals & Disputes, and Network Performance Standards.
• Experience in Medical Terminology, CPT, ICD-10 codes, etc.

Education

• Bachelor's degree or equivalent experience

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$54,300.00 - $119,340.00

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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This fulltime position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial wellbeing of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 09/30/2026

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