Provider Network Relationship Manager in Oh Work From Hom

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary: This is an individual contributor role. As part of the bold vision to deliver the “Next Generation” of managed care in Ohio Medicaid, Ohio RISE will help struggling children and their families by focusing on the individual with strong coordination and partnership among MCOs, vendors, and ODM to support specialization in addressing critical needs. The OhioRISE Program is designed to provide comprehensive and highly coordinated behavioral health services for children with serious/complex behavioral health needs involved in, or at risk for involvement in, multiple child-serving systems. This position assesses overall network composition and potential provider partners in order to identify and service partnerships that will advance and differentiate the OhioRISE Network. This executes, services and may negotiate contracts with local market providers in accordance with company and program standards to enhance provider networks and exceed accessibility, quality, and financial goals and cost initiatives. Key Responsibilities: Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships and partners in the development of business strategy and programs to support the operational plans. Collaborates cross-functionally to ensure resolution of escalated issues or

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Registered Nurse (RN) – Utilization Management Remote | Work from Home | Eastern Time Zone Preferred Are you an experienced RN looking to leverage your clinical expertise in a non-bedside role? Join our Utilization Management team and help ensure members receive the right care at the right time through evidence-based clinical review, care coordination, and healthcare advocacy. What You'll Do Review clinical information and apply established guidelines, policies, and clinical judgment to support coverage determinations Assess, coordinate, monitor, and evaluate healthcare services and benefits across the continuum of care Collaborate with providers and care teams to facilitate appropriate treatment and care planning Identify opportunities to improve quality of care, member outcomes, and healthcare utilization Connect members with additional programs and resources that support their healthcare needs Serve as a clinical resource for internal and external stakeholders WHAT YOU BRING - REQUIRED Active, unrestricted RN license in your state of residence 2+ years of adult acute care and/or critical care nursing experience Strong clinical assessment, critical thinking, and decision-making skills Excellent verbal and written communication skills Ability to multitask and

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Registered Nurse (RN) – Utilization Management Remote | Work from Home | Eastern Time Zone Preferred Are you an experienced RN looking to leverage your clinical expertise in a non-bedside role? Join our Utilization Management team and help ensure members receive the right care at the right time through evidence-based clinical review, care coordination, and healthcare advocacy. What You'll Do Review clinical information and apply established guidelines, policies, and clinical judgment to support coverage determinations Assess, coordinate, monitor, and evaluate healthcare services and benefits across the continuum of care Collaborate with providers and care teams to facilitate appropriate treatment and care planning Identify opportunities to improve quality of care, member outcomes, and healthcare utilization Connect members with additional programs and resources that support their healthcare needs Serve as a clinical resource for internal and external stakeholders WHAT YOU BRING - REQUIRED Active, unrestricted RN license in your state of residence 2+ years of adult acute care and/or critical care nursing experience Strong clinical assessment, critical thinking, and decision-making skills Excellent verbal and written communication skills Ability to multitask and