Provider Network Manager

TL;DR

Provider Network Manager (Medicare Advantage): Develop, maintain, and manage provider networks in assigned Kentucky geographic area with an accent on CMS STAR measures, closing clinical care gaps, and improving quality performance. Focus on negotiating contracts, analyzing performance data, educating providers on quality requirements, and collaborating with internal teams to implement improvement initiatives and enhance member outcomes.

Location: Fully remote - must be located in Kentucky

Salary: $80,000-$100,000 / year

Company

All-in-one healthcare company combining health insurance, clinical care, service, and technology to deliver high-quality care for older Americans across the United States.

What you will do

• Develop, maintain, and manage adequate provider network in assigned geographical area
• Maintain relationships, negotiate and renegotiate contracts with providers
• Identify opportunities to improve provider/member cost and quality performance
• Monitor compliance reports and report status, risks, and opportunities to leadership
• Support STAR measures improvement by educating providers, analyzing data, implementing workflows, and tracking performance
• Partner with quality, clinical, and analytics teams to translate insights into actionable strategies

Requirements

• Must be located in Kentucky with unrestricted driver's license
• 5+ years negotiating provider contracts including physician/group contracts with value-based/risk methodologies
• Provider servicing experience and local market relationships
• Experience in CMS STAR measures
• Solid ability to navigate Google or MS Suite
• High School Diploma or equivalent

Nice to have

• Quick independent decision-making
• Strong negotiation and project management skills
• Attention to detail and financial/performance report analysis
• Effective oral/written communication

Culture & Benefits

• Employer-sponsored health, dental, vision with low/no premiums
• Generous paid time off and parental leave
• 401K program, stock options, bonus eligibility
• $100 monthly mobile/internet stipend