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CVS Health Network Relations Consultant (WFH - NJ) in WORK FROM HOME, Pennsylvania

Job Description

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. Musthave prior negotiation experience working with andnegotiating contracts, terms and conditions as well asfinancial rate impacts with providers.

Required Qualifications

-Working knowledge of business segment specific codes,products, and terminology.-Must have prior negotiation experience working with andnegotiating contracts, terms and conditions as well asfinancial rate impacts with providers.-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.-Optimizes interactions with assigned providers andinternal business partners to establish and maintainproductive, professional relationships.-Monitors service capabilities and collaborates crossfunctionallyto ensure that the needs of constituents aremet and that escalated issues related but not limited to,claims payment, contract interpretation or parameters, andaccuracy of provider contract or demographic informationare 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, validates materials,and facilitates external provider meetings.-May collaborate cross-functionally on the implementation

COVID Requirements

COVID-19 Vaccination Requirement

CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.

  • If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.

  • If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications

  • 3+ years' experience in business segment environmentservicing providers with exposure to benefits and/orcontract interpretation.-Must have prior negotiation experience working with andnegotiating contracts, terms and conditions as well asfinancial rate impacts with providers.


-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.