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
Aetna Better Health of Pennsylvania, a CVS Health company is committed to partnering with the Department of Community Health, state agencies, providers, and our communities to ensure access to quality healthcare. Our dedication focuses on improving health outcomes, enhancing the lives our members through an integrated whole-person and resiliency building approach. We are seeking individuals who exemplify excellence, integrity, caring, and innovation to join our team where “Heart at Work” behaviors drive our success.  You can find your next opportunity here, and we will support you every step of the way. 

procedures specifically related to long term support services. 

• Providing LTSS educational guidance for Provider Relations team.

• Manages Local Provider Engagement Team to Deploy National Engagement Model.

• Manages Local Provider Relations staff to ensure Market Leading Provider Satisfaction.

• Responsible for maintenance of Provider Engagement related policies and procedures.

• Active participation in State and regulatory audits (HSAG, NCAQ, EQRO).

• Provides service to providers by resolving problems and advising providers of new protocols, policies, and procedures.

• Recommends training materials for staff and provider network; oversees staff responsible for initial and ongoing provider in-services and provider education; develops and implements provider satisfaction surveys.

• Researches, reviews, and prepares response for all governmental, regulatory and quality assurance provider complaints; timely and continuous reconciliation of provider records; oversees Provider Access and Availability by reviewing Appointment Availability Audits conducted by staff.

• Provides support and maintenance assistance for websites, portals, directories, manuals, and dashboards; plans, coordinates, and conducts provider forums and monthly webinars; develops communications including newsletters, notifications and Fax Blasts.

• Collaborates with growth partners, as needed, to obtain crucial or required information from Providers, such as HEDIS, Credentialing, Grievance and Appeals, SIU, etc. Coordinates provider status information with member services and other internal departments.

• Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including, employment, termination, performance reviews, salary reviews, and disciplinary actions. Monitors staff performance, including weekly staff metrics; coaches and mentors’ staff on performance issues or concerns.

• Provides service to providers by resolving problems and advising providers of new protocols, policies, and procedures.

• Recommends training materials for staff and provider network; oversees staff responsible for initial and ongoing provider in-services and provider education; develops and implements provider satisfaction surveys.

• Researches, reviews, and prepares response for all governmental, regulatory and quality assurance provider complaints; timely and continuous reconciliation of provider records; oversees Provider Access and Availability by reviewing Appointment Availability Audits conducted by staff.

• Provides support and maintenance assistance for websites, portals, directories, manuals, and dashboards; plans, coordinates, and conducts provider forums and monthly webinars; develops communications including newsletters, notifications and Fax Blasts.

• Collaborates with growth partners, as needed, to obtain crucial or required information from Providers, such as HEDIS, Credentialing, Grievance and Appeals, SIU, etc. Coordinates provider status information with member services and other internal departments.

• Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including, employment, termination, performance reviews, salary reviews, and disciplinary actions. Monitors staff performance, including weekly staff metrics; coaches and mentors’ staff on performance issues or concerns.

• Excellent interpersonal skills and the ability to work with others at all levels.

• Must be able to travel within the state and 1 out of state meeting per year.

Required Qualifications

• Minimum of 10 years job experience, 5 plus years leading a team.

• Knowledge of Medicaid and LTSS.

• Execution and delivery skills.

• Adept at collaboration and teamwork.

• Mastery of problem solving and decision making skills.

Preferred Qualifications

• Knowledge of Duals plans.

Education

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

Pay Range

The typical pay range for this role is:

$100,000.00 - $231,540.00

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.  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 Benefits | CVS Health

We anticipate the application window for this opening will close on: 12/31/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.