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CVS Health Network Relations Consultant (NYC) in New York, New York

Job Description

CVS now a Fortune 4 company!Acts as the primary resource for assigned, high profileproviders or groups (i.e. local, individual providers, smallgroups/systems) to establish, oversee, and maintainpositive relationships by assisting with or responding tocomplex issues regarding policies and procedures, plandesign, contract language, service, claims orcompensation issues, and provider education needs.- Optimizes interactions with assigned providers andinternal business partners to establish and maintainproductive, professional relationships.- Monitors service capabilities and collaborates crossfunctionally to ensure that the needs of constituents are met and that escalated issues related but not limited to, claims payment, contract interpretation or parameters, and accuracy of provider contract or demographic information are resolved.- Supports or assists with operational activities that mayinclude, but are not limited to, database management, andcontract coordination.- Performs credentialing support activities as needed.- Educates providers as needed to ensure compliance withcontract policies and parameters, plan design,compensation process, technology, policies, andprocedures.-Meets with key providers periodically to ensure servicelevels are meeting expectations.- Manages the development of agenda, validatesmaterials, and facilitates external provider meetingsof large provider systems, to manage cost drivers andexecute specific cost initiatives to support businessobjectives and to identify trends and enlist assistance inproblem resolution.- Conduct standard provider recruitment, contracting, or recontracting activities and assist with more complexcontracting and discussions as needed by businesssegment.Due to the business needs, this position will be located in NYC.

Required Qualifications

-Working knowledge of business segment specific codes,products, and terminology.- 3-5 years' experience with business segment specificpolicy, benefits, plan design and language.- Strong verbal and written communication, interpersonal,problem resolution and critical thinking skills.

Preferred Qualifications

  • 3+ years' experience in business segment environmentservicing providers with exposure to benefits and/orcontract interpretation.

Education

  • Bachelors degree or equivalent combination of educationand experience.

Business Overview

At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

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