Provider Network Manager Jobs in Covington, GA (NOW HIRING)

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Position Summary

• Entry levelcontracting rolefor a candidate with minimal contracting experience and background.
• Project managementskills to prioritize competing priorities, effectively communicate provider contracting scenarios with attention to detail based on a thorough evaluation of provider data using internal tools, and support and manage assigned projects for the market.
• Manages contract performance and drives the development and implementation of value-based contract relationships in support of business strategies.
• Recruitsproviders as needed to ensure attainment of network expansion and adequacy targets. Accountable for cost arrangements within defined providers.
• Collaboratescross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities.
• Responsible for identifying andmanaging cost issuesand collaborating cross functionally to execute significant cost saving initiatives.
• Represents companywith high visibility constituents, including customers and community groups. Promotes collaboration with internal partners.
• Evaluates, helps formulate, and implements the provider network strategic plans to achieve contracting targets and manage medical costs through effectiveprovider contractingto meet state contract and product requirements. Collaborates with internal partners to assess effectiveness of tactical plan in managing costs.
• May optimizeinteraction with assigned providersand internal business partners to facilitate relationships and ensureprovider needs are met. Ensuresresolution of escalated issuesrelated, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.

Required Qualifications

• 5+ years experience in a provider relations, contracting or managed care environment
• Knowledge of the managed care industry and practices, as well as a strong understanding of strategies, practices, and financial/contracting arrangements.
• Must possess critical thinking, problem resolution, organizational and interpersonal skills.
• Highly organized and self-driven
• Must reside in Georgia and able to drive into the Atlanta office location 1x per month

Preferred Qualifications

• Ability to forge meaningful, long-lasting relationships with providers.
• Physician, Ancillary and/or Commercial experience
• Knowledge of Medicare programs and related subject matter

Education

• Bachelor's degree and relevant training or work experience

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

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.

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

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