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About CVS Health – A Heart‑Centered Vision for the Future of Care
At CVS Health, our purpose is simple yet powerful: bringing our heart to every moment of your health. We are a national leader in pharmacy services, retail health, and innovative health‑technology solutions, and we are on a relentless mission to make health care more personal, convenient, and affordable. Our “Heart at Work” culture empowers every associate to act as a health‑care advocate, championing compassion, integrity, and collaboration every day.
As the health‑care landscape evolves—driven by new regulations, emerging technologies, and shifting patient expectations—CVS Health continues to pioneer integrated solutions that improve outcomes for millions of members. Joining our team means becoming part of an organization that not only values high‑impact work but also invests deeply in your professional growth, well‑being, and sense of purpose.
Position Overview – Why This Role Matters
The Remote Medicaid Network Provider Relations Manager for Maryland is a critical bridge between CVS Health’s Medicaid network and the providers who deliver essential health services to our members. You will be the primary point of contact for complex, high‑volume provider groups—including large hospital systems, regional health networks, and multi‑site clinics—ensuring that relationships are collaborative, compliance‑driven, and focused on high‑value health outcomes.
Working 100% from home, you will wield a diverse skill set that blends relationship management, regulatory expertise, data analysis, and strategic project leadership. Your day‑to‑day impact will be measured in provider satisfaction scores, network growth metrics, cost‑containment targets, and the seamless delivery of Medicaid services to members across Maryland.
Key Responsibilities – Driving Success Across the Provider Lifecycle
- Strategic Provider Partnerships: Partner with external provider engagement representatives and internal Provider Relations teams to nurture and expand high‑performing provider relationships, focusing on clinical quality, cost efficiency, and member access.
- Program Deployment: Lead the rollout of the Medicaid Provider Engagement program across local markets, ensuring consistent messaging, training, and performance tracking.
- Network Expansion & Compliance: Identify and recruit new providers that meet CVS Health’s rigorous network access criteria; oversee credentialing, contract negotiations, and ongoing compliance with Maryland Medicaid regulations.
- Education & Training: Design and deliver customized training modules and educational resources for providers and internal staff, aligning network functions with operations, claims processing, and quality improvement initiatives.
- Action Planning: Develop and execute Network Action Plans that address state compliance mandates, performance gaps, and strategic growth objectives.
- Advisory & Governance Meetings: Schedule, facilitate, and document both virtual and onsite Provider Advisory Group (PAG) and Joint Operating Committee (JOC) meetings, translating feedback into actionable quality and clinical measure improvements.
- Contract Monitoring & Auditing: Track executed provider contracts to verify that network access meets or exceeds state requirements; prepare reports for internal audits and regulatory reviews.
- Data Coordination: Collaborate with Provider Data Services, Member Services, and other internal departments to maintain accurate provider demographic information and support analytic initiatives.
- Issue Resolution & Communication: Provide best‑in‑class service by addressing provider concerns, disseminating updates on policies, protocols, and new initiatives, and ensuring timely resolution of grievances.
- Regulatory & Quality Assurance Support: Participate in weekly grievance and appeals meetings, trend analysis, and compliance tracking; respond to governmental and regulatory inquiries related to provider performance and quality metrics.
- Digital Platform Management: Maintain and enhance provider‑facing portals, directories, dashboards, and websites; lead webinars, forums, and newsletters that promote engagement and knowledge sharing.
- Cultural Competency Advocacy: Champion cultural competency education for providers, fostering inclusive care delivery that respects the diverse communities served across Maryland.
Essential Qualifications – The Foundation of Your Success
- Minimum 5+ years of experience in Provider Relations, preferably within Medicaid or other government‑funded health programs.
- Demonstrated expertise in Medicaid regulatory standards, including network access, credentialing, claims processing, and provider appeals.
- Strong analytical abilities, with a track record of using data to drive strategic decisions and improve provider performance.
- Exceptional interpersonal and communication skills, capable of influencing stakeholders at all organizational levels, from frontline clinicians to senior executives.
- Proven ability to manage multiple complex projects simultaneously while maintaining attention to detail and meeting tight deadlines.
- Willingness and ability to travel up to 50% of the time to provider sites, partner offices, and CVS Health locations across Maryland.
- Residency within the state of Maryland, with a preference for candidates residing in Baltimore or Anne Arundel County.
Preferred Qualifications – Enhancing Your Competitive Edge
- Experience working with large health‑system networks, multi‑site clinics, or regional provider groups.
- Advanced knowledge of HEDIS measures, SIU (Special Investigations Unit) processes, and quality improvement methodologies.
- Familiarity with digital engagement tools such as webinars, learning management systems, and provider portal technologies.
- Graduate‑level education or certifications in health‑care administration, public health, or related fields.
Education Requirements
A bachelor’s degree in health‑care administration, public health, business, or a related discipline is required. An equivalent combination of formal education and relevant professional experience will also be considered.
Core Competencies & Skills – What Sets a Top Performer Apart
- Strategic Thinking: Ability to translate high‑level business objectives into actionable provider initiatives.
- Regulatory Acumen: Deep understanding of Maryland Medicaid policies and the ability to interpret and apply them in day‑to‑day operations.
- Relationship Management: Skilled at building trust, influencing outcomes, and fostering long‑term collaborative partnerships.
- Data‑Driven Decision Making: Proficient with analytics tools, performance dashboards, and KPI reporting.
- Effective Presentation: Comfortable delivering clear, compelling presentations to diverse audiences, both virtually and in person.
- Problem Solving: Resourceful in identifying root causes and developing innovative solutions to complex provider challenges.
- Technology Savvy: Comfortable navigating provider portals, CRM systems, and virtual meeting platforms.
- Adaptability: Thrive in a fast‑changing environment, balancing competing priorities with composure and confidence.
Career Growth & Learning Opportunities
CVS Health is committed to nurturing talent and providing clear pathways for advancement. As a Remote Medicaid Network Provider Relations Manager, you will have access to:
- Professional Development Programs: Tuition assistance, certification sponsorship, and a library of free online courses covering health‑care policy, data analytics, leadership, and more.
- Mentorship & Coaching: Pairing with senior leaders across the Provider Relations, Clinical Operations, and Compliance functions to accelerate skill development.
- Cross‑Functional Exposure: Opportunities to work on enterprise‑wide initiatives, such as digital health integration, value‑based care contracts, and population health management.
- Leadership Tracks: Clear progression routes toward senior manager, director, or executive roles within the Medicaid network or broader provider strategy teams.
Work Environment & Culture – Why You'll Love Working Here
Although this role is fully remote, you’ll be part of a collaborative, mission‑driven community that values:
- Flexibility: Design your own workspace, set your own schedule (within required travel commitments), and achieve work‑life balance.
- Inclusion: A culture that celebrates diversity, equity, and inclusion, encouraging every voice to be heard and respected.
- Innovation: An environment that rewards creative problem‑solving and embraces new technology to improve health‑care delivery.
- Recognition: Regular acknowledgment of achievements through awards, peer‑to‑peer recognition, and performance‑based incentives.
- Community Impact: Direct contribution to improving health outcomes for vulnerable Medicaid populations across Maryland.
Compensation, Perks & Benefits – More Than Just a Salary
We offer a competitive salary range of $66,330 – $145,860 annually, calibrated based on experience, education, geography, and market factors. In addition to base pay, you may be eligible for performance‑based bonuses, commissions, or short‑term incentives.
Our comprehensive benefits package includes:
- Medical, dental, and vision coverage with a range of plan options.
- 401(k) retirement savings plan with employer matching contributions.
- Employee Stock Purchase Plan (ESPP) allowing you to buy CVS Health shares at a discounted rate.
- Fully paid term life insurance, short‑term and long‑term disability coverage.
- Generous paid time off (PTO), paid holidays, and sick leave in accordance with Maryland law.
- Well‑being programs covering mental health resources, fitness incentives, and nutrition guidance.
- Education assistance, including tuition reimbursement and access to free development courses.
- Exclusive CVS store discounts and partner‑program savings for you and your family.
How to Apply – Take the Next Step in Your Career
If you are passionate about shaping the future of Medicaid health‑care, building high‑impact relationships, and leading change from a remote environment, we want to hear from you. Apply today and bring your heart, expertise, and ambition to CVS Health.
Application Deadline: December 1, 2024
We are an equal‑opportunity employer. Qualified applicants with arrest or conviction records will be considered for employment in accordance with federal, state, and local laws.
Don’t Hesitate – Apply Now!
Even if you don’t meet every single qualification, your enthusiasm, commitment to learning, and drive to make a difference are what matter most. Click the link below to submit your application and begin the journey toward a rewarding career with CVS Health.
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