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Senior Manager, Provider Engagement (Oklahoma)

Job ID: R0207046
Category: Plan Operations

Address: 777 NW 63rd Street
Location: Oklahoma City, OK

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Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
 
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Position Summary

The Medicaid Sr. Manager, Provider Engagement manages and oversees compliance with our Provider Engagement responsibilities. 

•Reports to local market Lead Director
•Manages local PE team to deploy national engagement model
•Manages local PR staff to ensure Market Leading Provider Satisfaction scores
•Co-facilitates provider Advisory Group and JOC meetings to work with management to implement changes via coordination Quality Management to develop appropriate clinical measure improvements and implement those measures in the provider community
•Escalations: Provides service to providers by resolving problems and advising providers of new protocols, policies and procedures.
•Assist in creation of reports, attend, and present at Plan committee meetings (Grievance, SIC, etc.)
•Coordinate’s provider information with member services and other internal departments as requested. 
•Conduct shadowing during provider visits on-site, virtual, telephonic
•Monitor after-visit provider survey
•Provides service to providers by resolving problems and advising providers of new protocols, policies, and procedures. 
•Active participation in State and regulatory audits
•Travel within Market (approx 20%)
•Conference participation, as needed
•Other duties as assigned

Required Qualifications

  • Minimum of 5+ years recent Managed Care experience in Provider Relations & Employee Supervision with 2 – 3 years Medicaid Network experience
  • Excellent interpersonal skills and the ability to work with others at all levels 
  • Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and Network Performance Standards
  • Excellent analytical and problem-solving skills
  • Strong communication, negotiation, and presentation skills
  • Candidates are to reside within the state of Oklahoma

Preferred Qualifications
Proficient in Microsoft products

Education

Bachelor’s degree in a closely-related field or an equivalent combination of formal education and recent, related experience.

Pay Range

The typical pay range for this role is:

$67,900.00 – $149,300.00

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.  This position also includes an award target in the company’s equity award program. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. 
 
For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 08/02/2024

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