Job Abstract

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.

Position Summary
The Behavioral Health Senior Manager of Network Relations is a key role on the Aetna Better Health of NJ (ABHNJ) leadership team and is responsible for the management, oversight, and administration of ABHNJ’ s Behavioral Health Network. The Behavorial Health Senior Manager of Network Relations will report to the Executive Director of Network Management and will work in close partnership with the ABHNJ Behavioral Health Medical Director, Behavioral Health Administrator, CEO, COO, CMO, CFO, and all matrixed growth partners to expand the ABHNJ provider network to effectively manage behavioral health benefits and care. Successful candidate must live in New Jersey or be willing to relocate.

Required Qualifications
A full-time Behavioral Health Senior Manager of Network Relations must have an office located in New Jersey that they are able to utilize on a regular basis and shall have at least five (5) years of experience in managed care network management. Candidate must reside in New Jersey.

The primary functions of the BH Senior Manager of Network Relations are:

• Involvement in the development and maintenance of a credentialed Provider network that is geographically proportionate for provider specialties

• Meet provider services requirements under this Agreement

• Provide provider education and develop and deliver provider training

• Ensure network adequacy and appointment access, including development of network resources for identified unmet needs; this includes single case agreements, recruiting providers to meet unmet service capacity

• Ensure that contracted providers impacted by population health initiatives, such as quality improvement projects, are included on project teams to identify provider perceived barriers and provide input on design and intervention test that may impact providers

• Collaborate with other managed care entities to simplify provider requirements and remove administrative barriers across credentialing health plans and

• Develop and implement provider claim dispute resolution process

• Conduct access and availability rounds with care managers

Preferred Qualifications

• At least five (5) years of experience in managed care network management with demonstrated experience managing a behavioral health provider network

• Strong analytical skills and diligence, including executing provider agreements

• Persuasive communication skills, both written and verbal

• Strong political acumen with ability to effectively interact with providers, advocacy groups and State partners

• Excellent organization and time management skills

• Understanding of health plan operations, including contracting, claims processing, encounter data processing, and Medicaid eligibility and enrollment

• Experience navigating a matrixed organization

• Experience developing and executing project plans and processes

• NJ Medicaid regulatory experience

Education
Bachelor's Degree or equivalent experience
 

Pay Range

The typical pay range for this role is:

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.  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 jobs.CVSHealth.com/benefits