Our Ability Jobs

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Position Summary

This is a Field based role requiring 50% travel with in the state of Florida. Candidates must reside within one of the following counties to be considered:

• Tampa Bay or greater Tampa Bay area. Will visit providers in 5 Counties: Hillsborough, Polk, Manatee, Highlands, Hardee (REGION 6)

The Quality Provider Liaison builds positive relationships between Aetna Better Health (ABH) and its high-volume providers to facilitate high quality care for members. The Liaison achieves this goal through analyzing and sharing provider performance metrics related to quality, clinical outcomes, coding, and utilization used to support ABH programs. They will be a liaison between ABH providers and in select markets will be a part of the POD model consisting of an internal, cross-functional team of clinical, analytics, provider relations and medical personnel. The QPL will work both internally and externally with some travel time in the field to assigned provider offices.

Required Qualifications

• Bachelor’s degree in healthcare or related discipline or three years of relevant work experience or

• Three years’ experience in practice management or an administrative leadership role in primary care setting or

• Three years’ experience in managed care with a focus on HEDIS and Quality with experience facilitating and leading meetings with provider offices and proven track record of improving performance with your market

• Knowledge of HEDIS and Pay for Performance metrics, ICD-10 coding, Medicaid risk adjustment methodology, and common billing and common billing practices

• Demonstrated understanding of Medicaid industry standards and NCQA requirements

• Proficient in Microsoft Office tools

• Strong analytical skills regarding HEDIS metrics and quality reporting

• Articulate and professional communication skills, both verbally and written

• An ability to travel (up to three days a week) across the assigned territory for in-person provider support

• Valid driver’s license in good standing and access to a reliable vehicle required with insurance.

• Demonstrated experience in leading significant cross-functional work that includes business owners, executive leadership, and peers across the organization

Preferred Qualifications

• RHI, RHIT, CRC, or CPC certified Coder or auditor (CMAS) or

• RN or LPN or LISW or

• Three years’ experience in managed care with a focus on HEDIS and Quality

• Ability to manage relationships with an emphasis on internal and external mid-level relationships

• Ability to work across all levels of the organization, including working with executive audiences, vendors, and government as a customer

• Demonstrated ability to project manage and implement strategies to improve performance

Education

• Bachelor’s degree in healthcare or related discipline or three years of relevant work experience or

• Three years’ experience in practice management or an administrative leadership role in primary care setting

Pay Range

The typical pay range for this role is:

$54,300.00 - $119,340.00

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.

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 Benefits | CVS Health (https://jobs.cvshealth.com/us/en/benefits)

We anticipate the application window for this opening will close on: 11/30/2024

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

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.