Provider Network Manager (Healthcare)

TL;DR

Provider Network Manager (Healthcare): Managing and developing provider networks in assigned geographic areas with an accent on contract negotiation and relationship management. Focus on optimizing provider/member cost and quality performance and improving CMS STAR measures.

Location: Must be located in Washington or Oregon

Salary: $80,000–$110,000 per year

Company

A comprehensive healthcare company combining compassion, health insurance, clinical care, and technology to improve the well-being of older Americans.

What you will do

• Develop, maintain, and manage provider networks within the assigned geographical area.
• Negotiate and renegotiate provider contracts using various payment methodologies, including fee-for-service and value-based/risk models.
• Collaborate with internal experts and providers to identify opportunities for improving cost and quality performance.
• Monitor compliance reports and provide regular status updates, risks, and opportunities to leadership.
• Support the broader Network Team and work with assigned groups to improve CMS STAR measures performance.

Requirements

• 5+ years of experience negotiating provider contracts, specifically with physician groups and value-based/risk methodologies.
• Proven experience in provider servicing and existing relationships within the local market.
• Experience working with CMS STAR measures.
• High School Diploma or equivalent.
• Unrestricted driver's license for required driving responsibilities.
• Must be based in Washington or Oregon.

Nice to have

• Strong project management and financial analysis skills to identify trends and variances.
• Ability to make quick, independent decisions with a "big picture" understanding of network impacts.
• Highly effective oral and written communication skills.

Culture & Benefits

• Employer-sponsored health, dental, and vision plans with low or no premiums.
• Generous paid time off and a parental leave program.
• $100 monthly stipend for mobile or internet expenses.
• Stock options for all employees and bonus eligibility.
• 401K retirement program.