Provider Network Relationship Manager

CVS Health

. Assess overall network composition and potential provider partners .

Posted 9/22/2026full-timeRemote • Ohio • United StatesMid-LevelSenior💰 $60,300 - $132,600 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Medicaid Managed Care and provider relationship management, with a strong focus on compliance, contract negotiation, and performance monitoring. Proven ability to analyze healthcare claims data and drive strategic network initiatives within the Ohio managed care market.

Highest-signal resume keywords

Medicaid Managed Care ExperienceHealthcare Claims AnalysisContract Compliance ReviewProvider Relationship ManagementBehavioral Health Market Knowledge

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims Data AnalysisContract NegotiationPerformance MonitoringCompliance Issue IdentificationStrategic Network Configuration

Soft Skills

Strong CommunicationCritical ThinkingProblem ResolutionInterpersonal Skills

Tools & Technologies

MS Office Suite

Industry Keywords

Ohio Managed Care MarketBehavioral Health ProvidersProvider SystemsNetwork ExpansionContract Policies

About the role

Key responsibilities & impact

Assess overall network composition and potential provider partners
Identify and service partnerships that advance and differentiate the OhioRISE Network
Execute, service, and potentially negotiate contracts with local market providers
Establish and maintain productive relationships with assigned providers and internal business partners
Partner in developing business strategy and programs supporting operational plans
Resolve escalated issues and projects for assigned provider systems
Monitor performance and adherence to scorecards and payout schedules
Educate internal and external parties on contract policies, plan design, compensation processes, technology, and performance measurement
Meet periodically with key providers to ensure service levels meet expectations
Develop agendas, validate materials, and facilitate external provider meetings
Collaborate on implementation of large provider systems, cost-driver management, data reports, and cost initiatives
Drive provider engagement and recruit providers as needed to achieve network expansion and adequacy targets
Assist with strategic network configuration and integration activities
Serve as a subject matter expert for less experienced team members and internal partners

Requirements

What you’ll need

5+ years of experience in Medicaid managed care
Proven track record working with individual providers and complex provider systems or groups
Minimum of 2 years of experience reviewing, analyzing, and auditing healthcare claims and claims data
Experience identifying discrepancies, researching and resolving claim issues, and providing insights to support claims administration
Experience reviewing contracts for compliance with applicable state regulatory requirements
Experience identifying potential compliance issues and ensuring contractual terms align with regulations and standards
Strong communication, critical thinking, problem-resolution, and interpersonal skills
Must reside in the state of Ohio
Ability to travel within Ohio as needed
Proficiency with MS Office Suite applications
In-depth knowledge of behavioral health market preferred
Experience building and maintaining relationships with behavioral health providers preferred
In-depth knowledge of Ohio managed care market preferred
Bachelor's degree preferred, or a combination of professional work experience and education

Benefits

Comp & perks

CVS Health bonus, commission or short-term incentive program
Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being