Provider Relationship Manager Jobs (NOW HIRING)

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Position Summary:
As part of the bold vision to deliver the "Next Generation" of managed care in Ohio Medicaid, Ohio RISE will help struggling children and their families by focusing on the individual with strong coordination and partnership among MCOs, vendors, and ODM to support specialization in addressing critical needs. The OhioRISE Program is designed to provide comprehensive and highly coordinated behavioral health services for children with serious/complex behavioral health needs involved in, or at risk for involvement in, multiple child-serving systems.

This is an individual contributor role.

This position assesses overall network composition and potential provider partners in order to identify and service partnerships that will advance and differentiate the OhioRISE Network. This executes, services and may negotiate contracts with local market providers in accordance with company and program standards to enhance provider networks and exceed accessibility, quality, and financial goals and cost initiatives.
Key Responsibilities:

• Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships and partners on the development of business strategy and programs to support the operational plans.
• Collaborates cross-functionally to ensure resolution of escalated issues or projects for assigned provider systems and monitors performance and adherence to scorecards and payout schedules based on established quality, growth, and clinical measures.
• Educates internal and external parties as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, performance measurement techniques, policies, and procedures.
• Meets with key providers periodically to ensure service levels are meeting expectations.
• Manages the development of agenda, validates materials, and facilitates external provider meetings.
• May collaborate cross-functionally on the implementation of large provider systems, to manage cost drivers, data reports and execute specific cost initiatives to support business objectives and to identify trends and enlist assistance in problem resolution.
• May be responsible for provider recruitment, contracting, or re-contracting activities, or may assist and support more complex contracting and discussions.
• Drives provider engagement, and may recruit providers, as needed to ensure attainment of network expansion and adequacy targets.
• Assists with the design, development, management, and or implementation of strategic network configurations and integration activities.
• Serves as SME for less experienced team members and internal partners.

Required Qualifications:

• 5+ years of experience in Medicaid managed care, with a strong ability to influence and a proven track record of successfully negotiating and managing contracts with individual providers and complex provider systems or groups. Experience in Behavioral Health contracting is strongly preferred.
• Understands the regulatory environment and ensures contractual compliance with state requirements.
• Strong communication, critical thinking, problem resolution and interpersonal skills.
• Candidates must reside in the state of Ohio.
• Ability to travel in-state as needed.
• Computer literate; proficiency with MS Office Suite applications.

Preferred Qualifications:

• In depth knowledge of behavioral health market and strong experience building and maintaining relationships with Behavioral Health providers.
• In depth knowledge of Ohio managed care market, Medicaid preferred.

Education:

• Bachelor's degree preferred or a combination of professional work experience and education.

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.