Provider Network Manager

TL;DR

Provider Network Manager (Healthcare): Development, maintenance, and management of provider networks in assigned geographic areas with an accent on Medicare Advantage quality programs, CMS STAR measures, and contract negotiations using fee-for-service and value-based methodologies. Focus on identifying care gaps, improving quality performance, educating providers on STAR requirements, and implementing workflows to enhance member outcomes and plan performance.

Fully Remote - Connecticut. Experience and relationships in the local market required. Assigned geographic area within US.

$80,000-$100,000 / year

Company

Health insurance company combining compassion, clinical care, service, and technology to deliver integrated healthcare solutions for older Americans, serving members across the United States.

What you will do

• Develop, maintain, and manage adequate provider networks in assigned geographical areas.
• Maintain relationships, negotiate, and renegotiate contracts with providers.
• Engage providers and internal experts to improve cost and quality performance.
• Monitor compliance reports and report status, risks, and opportunities to leadership.
• Support CMS STAR measures improvement by educating providers, analyzing data, implementing initiatives, and tracking performance via dashboards.
• Partner with quality, clinical, and analytics teams to translate insights into actionable strategies for providers.

Requirements

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

Nice to have

• Quick, independent decision-making
• Mutually beneficial negotiation skills
• Strong project management skills
• Attention to detail
• Ability to analyze financial/performance reports and identify trends
• Big picture thinking and effective communication skills

Culture & Benefits

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