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Manager, Provider Relations – National Health Systems
CVS Health. Manage relationships with assigned strategic providers .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in managing provider relationships and resolving complex operational issues within healthcare operations. Proficient in analyzing provider performance and supporting value-based care initiatives while ensuring compliance with regulatory standards.
Highest-signal resume keywords
Healthcare Operations ExperienceProvider Relations ManagementClaims Processing KnowledgeAnalytical Problem-Solving SkillsStrong Communication Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims ProcessingProvider EnrollmentCredentialingProvider Data ManagementReimbursement FundamentalsOperational AnalyticsRoot Cause AnalysisProvider ReportingValue-Based Care ProgramsNetwork Management
Soft Skills
CollaborationProblem-SolvingPresentation SkillsTime ManagementVerbal Communication
Tools & Technologies
Microsoft ExcelMicrosoft PowerPointData Analysis Tools
Industry Keywords
Managed CareMedicareMedicaidACA ProductsProvider ServicesHealthcare OrganizationsOperational EfficiencyMember ExperienceNetwork AdequacyRegulatory Compliance
About the role
Key responsibilities & impact- Manage relationships with assigned strategic providers
- Serve as a primary point of contact for provider operational issues, inquiries, and escalations
- Investigate and resolve complex provider concerns involving claims, rework, appeals, provider data, credentialing, and reimbursement
- Partner with Claims, Appeals, Operations, Provider Data, Credentialing, Medical Management, and Contracting teams
- Analyze provider service trends, operational performance, and issue root causes
- Support provider performance initiatives related to quality, access, operational efficiency, and member experience
- Educate providers on health plan programs, administrative processes, self-service tools, and operational requirements
- Support value-based care initiatives through provider engagement, education, and operational support
- Assist with network adequacy activities, provider recruitment, and regulatory initiatives
- Research and respond to provider complaints, disputes, executive escalations, and regulatory inquiries
- Monitor provider issues through resolution and communicate status updates
- Support implementation of network and operational initiatives affecting providers
- Prepare provider-facing materials, business summaries, issue analyses, and leadership updates
- Ensure compliance with contractual requirements, regulatory standards, and company policies
- Support special projects and cross-functional initiatives
Requirements
What you’ll need- 4+ years of experience in healthcare operations, provider relations, network management, managed care, claims, provider services, or related healthcare experience
- Demonstrated experience working directly with physicians, hospitals, ancillary providers, or healthcare organizations
- Experience researching and resolving complex operational or provider-related issues
- Strong analytical and problem-solving skills
- Understanding of healthcare operations including claims processing, provider enrollment, credentialing, provider data management, and reimbursement fundamentals
- Ability to collaborate effectively across a highly matrixed organization
- Strong verbal, written, and presentation communication skills
- Ability to manage multiple priorities simultaneously and deliver results in a fast-paced environment
- Proficiency with Microsoft Excel, PowerPoint, and data analysis tools
- Bachelor's degree or equivalent combination of education and relevant professional experience
- Experience supporting complex and strategic provider organizations
- Knowledge of Commercial, Medicare, Medicaid, and ACA products
- Experience resolving provider claims and reimbursement issues
- Experience handling provider disputes, executive complaints, regulatory inquiries, or escalated operational issues
- Familiarity with provider network operations, provider data management, credentialing, and enrollment processes
- Knowledge of value-based care programs and provider performance initiatives
- Experience with provider reporting, operational analytics, and root cause analysis
Benefits
Comp & perks- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being
- CVS Health bonus, commission or short-term incentive program in addition to base pay