Provider Network Manager (Healthcare)

TL;DR

Provider Network Manager (Healthcare): Developing and managing a provider network in an assigned geographic area with an accent on Medicare Advantage quality programs and CMS STAR measures. Focus on negotiating complex provider contracts and implementing quality improvement workflows to enhance member outcomes.

Location: Fully Remote (Must be based in Connecticut, USA)

Salary: $80,000–$100,000 / year

Company

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

What you will do

• Develop and manage an adequate provider network within the assigned geographic area.
• Negotiate and renegotiate contracts with physicians and health systems using fee-for-service and value-based/risk payment methodologies.
• Collaborate with providers to identify and close clinical care gaps and improve CMS STAR performance.
• Monitor compliance reports and communicate risks and opportunities to leadership.
• Utilize performance dashboards to track HEDIS metrics and other quality indicators.
• Partner with internal clinical and analytics teams to translate data insights into actionable provider strategies.

Requirements

• 5+ years of experience negotiating provider contracts, including value-based/risk models.
• Proven experience in provider servicing and network management.
• Direct experience with CMS STAR measures and existing relationships in the local market.
• Must be based in Connecticut, USA.
• Unrestricted driver's license for site visits and provider verification.
• High School Diploma or equivalent.

Nice to have

• Strong project management and financial analysis skills.
• Ability to make quick, independent decisions.
• Excellent oral and written communication skills.

Culture & Benefits

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