Provider Network Manager
Role Overview
The Provider Network Manager is primarily responsible for establishing CMS-compliant, cost-effective and competitive healthcare provider networks in assigned markets by negotiating agreements with healthcare providers. Responsibilities also include maintaining positive business relationships with contracted providers and reporting on material changes in assigned markets while serving as a subject matter expert (SME) for other functional areas within the organization.
Key Skills for This Role
Full Job Posting
Benefits and Perks include
- Affordable Medical/Dental/Vision insurance options
- Generous paid time-off program and paid holidays for full time staff
- TeleDoc 24/7/365 access to doctors
- Optional short- and long-term disability plans
- Employee Assistance Plan (EAP)
- 401K retirement accounts with company match
- Employee Referral Bonus Program
JOB SUMMARY
The Provider Network Manager is primarily responsible for establishing CMS-compliant, cost-effective and competitive healthcare provider networks in assigned markets by negotiating agreements with healthcare providers. Responsibilities also include maintaining positive business relationships with contracted providers and reporting on material changes in assigned markets while serving as a subject matter expert (SME) for other functional areas within the organization.
ESSENTIAL JOB DUTIES
- To perform this job, an individual must accomplish each essential function satisfactorily, with or without reasonable accommodation.
- Execute agreements with healthcare providers & essential vendors in assigned markets to establish competitive and cost-effective healthcare provider networks, which also meet CMS network adequacy standards.
- Ensure providers and essential vendors meet the credentialing requirements
- Analyze the Health Plan(s) provider network to maintain network adequacy on an ongoing basis
- Support implementation of Health Plan(s) in new markets as needed
- Establish a positive work environment that encourages participation in process improvement and commitment to department/company success
- Complete corporate assignments, including but not limited to compliance training, as assigned
JOB REQUIREMENTS
- Must have knowledge and familiarity with all levels of medical services and ability to rapidly develop working relationships
- Must be able to accept instructions and work independently in the completions of goals and assignments
- Must have strong negotiation, organization, presentation, and time management skills
- Must be able to effectively communicate with medical staff to explain the Health Plan(s) program, benefits, and goals
- Must be able to work effectively in a team environment
- Excellent computer skills, including Microsoft Office Suite
- Must be self-motivated, dependable, team and goal oriented
- Successful completion of required training
- Handle multiple priorities effectively
- Independent discretion/decision making
- Reliable transportation
- Current automobile insurance according to company policy
REQUIRED QUALIFICATIONS
- Education:
- o Bachelor’s degree or equivalent work experience
- o Five (5) plus years of experience in managed care/network development/ network services
- Experience:
- o Experience in the health care field required
- o Prior experience with Medicare Advantage plans is helpful
- o Prior experience in network development/network services is required
- o Prior experience with acute and post-acute facilities is beneficial
WORKING CONDITIONS
• Must be available to work 8 a.m. until 5 p.m. local time. Occasionally, extended hours may be required for special projects.
• Position requires intermittent travel to network provider locations
• Teleworking is an option if criteria is met
EQUAL OPPORTUNITY EMPLOYER
This Organization is an equal opportunity employer. We do not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. This Organization will make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made. A key part of this policy is to provide equal employment opportunity regarding all terms and conditions of employment and in all aspects of a person's relationship with the Organization including recruitment, hiring, promotions, upgrading positions, conditions of employment, compensation, training, benefits, transfers, discipline, and termination of employment.
This employer participates in E-Verify.
About American Health Plans
Parent group profile
American Health Partners
Private healthcare company serving seniors through Medicare Advantage plans, care coordination, psychiatric hospitals, and long-term-care pharmacy services.
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