Texas Medicaid Provider Engagement Senior Manager

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.Aetna Better Health of Texas, a CVS Health company is committed to partnering with the Department of Community Health, state agencies, providers, and our communities to ensure access to quality healthcare. Our dedication focuses on improving health outcomes, enhancing the lives our members through an integrated whole-person and resiliency building approach. We are seeking individuals who exemplify excellence, integrity, caring, and innovation to join our team where “Heart at Work” behaviors drive our success. You can find your next opportunity here, and we will support you every step of the way.Position SummaryThe Medicaid Sr. Manager, Provider Engagement manages and oversees compliance with our Provider Engagement responsibilities.

Manages local PR staff to ensure Market Leading Provider Satisfaction scores

Co-facilitates provider Advisory Group and JOC meetings to work with management to implement changes via coordination Quality Management to develop appropriate clinical measure improvements and implement those measures in the provider community

Escalations: Provides service to providers by resolving problems and advising providers of new protocols, policies and procedures.

Assist in creation of reports, attend, and present at Plan committee meetings (Grievance, SIC, etc.)

Coordinate’s provider information with member services and other internal departments as requested.

Conduct shadowing during provider visits on-site, virtual, telephonic

Monitor after-visit provider survey

Maintain local policies and procedures

Provides service to providers by resolving problems and advising providers of new protocols, policies, and procedures.

Active participation in State and regulatory audits

Travel within Market as needed

Conference participation, as needed

Other duties as assigned

Required Qualifications

Must reside in Texas. Preferably in Harris, Dallas, Hidalgo, or Travis Counties. Central Texas is a desired location as well

Minimum of 5+ years recent Managed Care experience in Provider Relations & Employee Supervision with 2 - 3 years Medicaid Network experience

Experience leading / managing staff to ensure department goals are met.

Medicaid experience including knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and Network Performance Standards

Excellent analytical and problem-solving skills

Travel within market as needed

Preferred Qualifications:

Strong communication, critical thinking, problem resolution, interpersonal skills, organizational and time management skills.

Team player with proven ability to develop strong working relationships within a fast-paced, matrix organization. 

Proficient in Microsoft products

Demonstrated ability to influence and collaboration with internal and external partners via strong written and verbal communications. 

Demonstrated ability to identify and manage initiatives that improve total medical cost and quality. 

Education:Bachelor’s degree in a closely-related field or an equivalent combination of formal education and recent, related experience.Pay RangeThe typical pay range for this role is:$75,400.00 - $165,954.00This 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. This position also includes an award target in the company’s equity award program.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: 10/31/2024Qualified 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.