Behavioral Health Network Relations Manager

This is a fully remote position, open to applicants in Louisiana.

📋 Description

• Serve as the primary contact for designated high-profile Behavioral Health providers and/or groups.

• Build, manage, and sustain positive relationships with providers.

• Address complex matters related to Medicaid policies and procedures, plan design, contract language, service, claims, compensation, and provider education.

• Enhance interactions with assigned providers and internal business partners.

• Monitor service capabilities and work collaboratively across departments to address escalated claims, contracts, and provider information issues.

• Assist with operational tasks, including database management and contract coordination.

• Conduct credentialing support activities as necessary.

• Inform Medicaid providers about contract policies, plan design, compensation processes, technology, policies, and procedures.

• Regularly meet with key providers to ensure service levels align with expectations.

• Develop meeting agendas, verify materials, and lead external provider meetings.

• Collaborate on the implementation of extensive provider systems, cost drivers, cost initiatives, trend identification, and issue resolution.

• Offer guidance and training to less experienced team members.

• Partner with Provider Enablement & Strategy on provider-facing communications, desktops, workflows, external training, reporting needs, and HUB support.

• Carry out additional duties as assigned.

⛳️ Requirements

• At least 5 years of experience in the healthcare field.

• A minimum of 3 years of experience in a Medicaid Managed Care business segment environment servicing providers, with familiarity in benefits and/or contract interpretation.

• At least 2 years of experience working with providers and contracts within the behavioral health sector.

• Working knowledge of business segment-specific codes, products, and terminology.

• Proficiency in Microsoft Office Suite, including Excel, Word, and PowerPoint.

• Willingness to travel within the designated territory up to 50-80% of the time.

• Candidates must live in the state of Louisiana and within one of the following parishes: St. Landry, Evangeline, Acadia, Lafayette, St. Martin, Iberia, Vermillion, Beauregard, Allen, Calcasieu, Jefferson Davis, Cameron, Avoyelles, Rapides, Vernon, Grant, Winn, LaSalle, Catahoula, Concordia.

• Knowledge of Medicaid Regulatory Standards regarding Network Access, Credentialing, Claim Lifecycle, Provider Appeals & Disputes, and Network Performance Standards.

• Familiarity with Medical Terminology, CPT, ICD-10 codes, etc.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program in addition to base salary.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being.