Job Description
Candidate must be within a commutable distance to Princeton, NJ.

– Acts as the primary resource for assigned, high profile
providers or groups (i.e. local, individual providers, small
groups/systems) to establish, oversee, and maintain
positive relationships by assisting with or responding to
complex issues regarding policies and procedures, plan
design, contract language, service, claims or
compensation issues, and provider education needs.
– Optimizes interactions with assigned providers and
internal business partners to establish and maintain
productive, professional relationships.
– Monitors service capabilities and collaborates cross-
functionally to ensure that the needs of constituents are
met and that escalated issues related but not limited to,
claims payment, contract interpretation or parameters,
and accuracy of provider contract or demographic
information are resolved.
– Supports or assists with operational activities that may
include, but are not limited to, database management,
and contract coordination.
– Performs credentialing support activities as needed.
– Educates providers as needed to ensure compliance
with contract policies and parameters, plan design,
compensation process, technology, policies, and
procedures.
– Meets with key providers periodically to ensure service
levels are meeting expectations. Manages the
development of agenda, validates materials,
and facilitates external provider meetings.
– May collaborate crossfunctionally on the implementation
of large provider systems, to manage cost drivers and
execute specific cost initiatives to support business
objectives and to identify trends and enlist assistance in
problem resolution.
– Conduct standard provider recruitment, contracting, or
recontracting activities and assist with more complex
contracting and discussions as needed by business
segment.
– May provide guidance and training to less experienced
team members.

Required Qualifications
– 3+ years’ experience in business segment environment
servicing providers with exposure to benefits and/or
contract interpretation.
– 3-5 years’ experience with business segment specific
policy, benefits, plan design and language.
– Strong verbal and written communication, interpersonal,
problem resolution and critical thinking skills.
– Working knowledge of business segment specific codes,
products, and terminology.

COVID Requirements
COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.

• If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.

• If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications
– Medicaid background

Education
– Bachelor’s Degree or equivalent combination of education
and experience.

Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities