Network Relations Manager (LTSS)

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary
Acts as the primary resource for assigned, providers in a geographic location to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding Medicaid policies and procedures, service, claims or compensation issues, and provider education needs.

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  Specialize in supporting Long-Term Services and Supports (LTSS) and Physical Health providers.
  
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  Meets regularly, both in person and virtually, with assigned providers to conduct trainings and education, including required annual trainings, ensure understanding of Aetna policies and procedures, explain Aetna systems, etc.
  
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  Serves as primary relationship manager with LTSS and HCBS providers and/or PH and BH providers to ensure positive provider experience with Aetna Better Health and promote network retention.
  
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  Supports new assigned providers with onboarding, including orientation session(s).
  
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  Responds to assigned provider questions or inquires, and if necessary, ensures prompt resolution to provider issues with appropriate enterprise business teams, including those associated with claims payment, prior authorizations, and referrals, as well as appropriate education about participation in Aetna Better Health of PA plan.
  
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  Convenes Joint Operating Committee meetings with providers, including organizing agendas, materials, and other growth partners (clinical, provider engagement), to discuss key operational, clinical, and quality related topics.
  
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  Travel required within your assigned territory.
  
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  Other duties as assigned.
  

Required Qualifications

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  3+ years' experience in Medicaid Managed Care business segment environment servicing providers with exposure to benefits and/or contract interpretation
  
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  Experience working with LTSS providers.
  
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  Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills
  
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  Working knowledge of business segment specific codes, products, and terminology
  
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  Must reside in the state of PA.
  

Preferred Qualifications

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  Certified Billing and Coding Specialist (CBCS) preferred.
  

Education

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  Bachelor's degree or equivalent professional work experience.
  

Anticipated Weekly Hours
40

Time Type
Full time

Pay Range

The typical pay range for this role is:

$54,300.00 - $132,600.00

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 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:

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  Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
  
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  No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
  
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  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/benefits

We anticipate the application window for this opening will close on: 05/24/2025

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