Manager, Provider Relations

CVS Health

CVS Health provider relations manager supporting Medicaid policies, provider systems, credentialing, and claims operations. Ensuring contractual service standards for Aetna Better Health of Oklahoma.

Posted 8/18/2026full-timeRemote • Oklahoma • 🇺🇸 United StatesMid-LevelSenior💰 $54,300 - $119,340 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in Medicaid policies, provider credentialing, and claims management while effectively leading teams and collaborating cross-functionally to enhance service delivery and operational efficiency.

Highest-signal resume keywords

Medicaid Plan ExperienceLeadership ExperienceKnowledge of QNXTProvider CredentialingStrong Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Mapping and CertificationDatabase ManagementClaims Payment ResolutionMedical TerminologyCPT CodesICD-10 Codes

Soft Skills

Problem ResolutionCritical ThinkingInterpersonal Skills

Tools & Technologies

QuickbaseWFM (Workflow Manager Tool)

Industry Keywords

Medicaid Regulatory StandardsProvider AppealsNetwork Performance Standards

About the role

Key responsibilities & impact

Act as the primary resource for an internal team responding to inquiries about Medicaid policies and procedures, plan design, contract language, service, claims, compensation issues, and provider education needs
Monitor service capabilities and collaborate cross-functionally to meet constituent needs
Resolve escalated issues involving claims payment, contract interpretation or parameters, and provider contract or demographic information accuracy
Support operational activities including database management and contract coordination
Perform Tin Mapping/Certification and credentialing support activities
Collaborate on implementation of large provider systems, manage cost drivers, execute cost initiatives, identify trends, and enlist assistance in problem resolution
Provide guidance and training to less experienced team members
Collaborate with Provider Enablement & Strategy on provider-facing communications, desktops, workflows, external trainings, reporting needs, and HUB support
Ensure all turnaround times are met according to the state contractual agreement with Aetna Better Health of Oklahoma
Perform other duties as assigned

Requirements

What you’ll need

5+ years' work experience in a leadership role
Experience working in a Medicaid plan
Knowledge of QNXT, Quickbase, and WFM (Workflow Manager tool)
Strong knowledge of mapping and certification of providers
Must reside in Oklahoma
Knowledge of Medicaid regulatory standards for network access, credentialing, claim lifecycle, provider appeals and disputes, and network performance standards
Experience in medical terminology, CPT, ICD-10 codes, etc.
Bachelor's degree or equivalent experience
Strong verbal and written communication, interpersonal, problem resolution, and critical thinking skills

Benefits

Comp & perks

Medical, dental, and vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being
CVS Health bonus, commission or short-term incentive program in addition to base pay