Network Management Analyst

CVS Health

2.7

(75)

Plantation, FL

Why you should apply for a job to CVS Health:

  • 62% say women are treated fairly and equally to men
  • 52% say the CEO supports gender diversity
  • Ratings are based on anonymous reviews by Fairygodboss members.

    #R0246319

    Position summary

    al vendors and internal team members.

    • Key responsibilities include:

    • Responsible for the management of the AI Network Management mailbox; answering or triaging network related questions

    • Assist with the Network TPA Compliance Assessment process as needed

    • Assist with Sales support process - network support / RFP - RFI inquiry support

    • Maintain and support on QuickBase and SharePoint to ensure all network related materials and documents are up to date.

    • Assist with GU Health enrollment and mailbox management

    • Responsible for all processes, reports, and management of AI provider nominations

    • Responsible for maintaining the data in the Provider Nominations QuickBase

    • Ensures that scheduled reports are accurate and delivered timely to recipients

    • Coordinates with Allianz Network team to ensure the timely updates on nominations referred to Allianz

    • Responsible for the management of the AI Provider Nominations mailbox

    • Responsible for the certification of all new and continuing directly contracted providers in the Aetna International Direct Pay Network

    • Responsible for monitoring the status of all directly contracted providers' licenses and updating the validation upon expiration or at least every 3 years (long term licenses)

    • Responsible for escalating non-compliant providers for review by Network Lead Directors

    • Responsible for maintaining the provider participation standards for all countries in which Aetna has directly contract provider relationships

    • Reviewing submitted contracts prior to provider/TPA (third party administrator) signature to ensure contract is in compliance with current Aetna International contract policies

    • Responsible for saving final/fully executed provider agreements in the Provider / TPA folders on the applicable SharePoint/shared drives

    • Responsible for the management of all Provider and TPA agreements ensuring that they maintain incompliance with CVS Health Records Retention policies.

    • Support various network projects as needed.

    Required Qualifications

    • 2+ years of health insurance and/or provider network setup experience.

    Preferred Qualifications

    • Spanish language speaker preferred

    Education

    • Bachelors degree or equivalent experience.

    Pay Range

    The typical pay range for this role is:

    $40,600.00 - $85,100.00

    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.

    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

    We anticipate the application window for this opening will close on: 06/28/2024

    Why you should apply for a job to CVS Health:

  • 62% say women are treated fairly and equally to men
  • 52% say the CEO supports gender diversity
  • Ratings are based on anonymous reviews by Fairygodboss members.