Manager, Provider Relations (Metro, NY)

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Position Summary

Aetna is seeking a Manager Provider Relations to support the Metro New York market. This role is responsible for managing provider relationships and supporting provider service operations for physicians hospitals ancillary providers and health systems. The Manager Provider Relations serves as a key liaison between providers and internal business partners driving issue resolution operational excellence provider engagement and network performance. The Manager will collaborate across Network Management Claims Operations Medical Management Finance Provider Data Credentialing and Contracting teams to resolve complex provider issues improve provider experience and support strategic business objectives. The ideal candidate possesses strong analytical and problem-solving skills healthcare industry knowledge and the ability to build productive relationships with provider organizations in one of Aetnas largest and most complex markets.

Key Responsibilities

• Manage relationships with assigned hospitals

• Serve as a primary point of contact for provider operational issues inquiries and escalations.

• Investigate and resolve complex provider concerns related to claims rework appeals provider data credentialing and reimbursement issues.

• Partner with cross-functional teams including Claims Appeals Operations Provider Data Credentialing Medical Management and Contracting to drive issue resolution and improve provider experience.

• Analyze provider service trends operational performance and issue root causes to identify improvement opportunities.

• Support provider performance initiatives related to quality access operational efficiency and member experience.

• Educate providers on health plan programs administrative processes self-service tools and operational requirements.

• Support value-based care initiatives through provider engagement education and operational support.

• Assist with network adequacy activities provider recruitment efforts and regulatory initiatives as needed.

• Research and respond to provider complaints disputes executive escalations and regulatory inquiries.

• Monitor provider issues through resolution and communicate status updates to internal and external stakeholders.

• Support implementation of network and operational initiatives impacting providers.

• Prepare provider-facing materials business summaries issue analyses and leadership updates.

• Ensure compliance with contractual requirements regulatory standards and company policies.

• Support special projects and cross-functional initiatives as assigned.

Required Qualifications

• 4 years of experience in healthcare operations provider relations network management managed care claims provider services or related healthcare experience.

• Demonstrated experience working directly with physicians hospitals ancillary providers or healthcare organizations.

• Experience researching and resolving complex operational or provider-related issues.

• Strong analytical and problem-solving skills with the ability to evaluate information identify root causes and drive resolution.

• Understanding of healthcare operations including claims processing provider enrollment credentialing provider data management and reimbursement fundamentals.

• Ability to collaborate effectively across a highly matrixed organization.

• Strong verbal written and presentation communication skills.

• Ability to manage multiple priorities simultaneously and deliver results in a fast-paced environment.

• Proficiency with Microsoft Excel PowerPoint and data analysis tools.

Preferred Qualifications

• Experience supporting provider organizations within the Metro New York market.

• Knowledge of Commercial Medicare Medicaid and ACA products.

• Experience resolving provider claims and reimbursement issues.

• Experience handling provider disputes executive complaints regulatory inquiries or escalated operational issues.

• Familiarity with provider network operations provider data management credentialing and enrollment processes.

• Knowledge of value-based care programs and provider performance initiatives.

• Experience with provider reporting operational analytics and root cause analysis.

Education

• Bachelors degree or equivalent combination of education and relevant professional experience.

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

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.

Our people fuel our future. Our teams reflect the customers patients members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

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