Provider Network Manager (Healthcare)

TL;DR

Provider Network Manager (Healthcare): Managing and developing provider networks in Ohio and Michigan with an accent on contract negotiation and Medicare Advantage quality performance. Focus on closing clinical care gaps, improving CMS STAR measures, and optimizing member outcomes.

Location: Remote (Must be located in Ohio or Michigan)

Salary: $80,000 - $110,000 / year

Company

hirify.global is an all-in-one healthcare company on a mission to dramatically improve the health and well-being of older Americans.

What you will do

• Develop, maintain, and manage a provider network within the assigned geographic area.
• Negotiate and renegotiate contracts with physicians, physician groups, and health systems using fee-for-service and value-based payment methodologies.
• Collaborate with providers to improve CMS STAR measures, educate staff on requirements, and close clinical care gaps.
• Monitor compliance reports and utilize performance dashboards to track HEDIS metrics and quality indicators.
• Partner with internal quality, clinical, and analytics teams to translate data insights into actionable strategies for providers.
• Report current status, risks, and potential opportunities in the area of responsibility to leadership.

Requirements

• 5+ years of experience negotiating provider contracts (including value-based/risk methodologies).
• Proven experience in provider servicing and CMS STAR measures.
• Must be located in Ohio or Michigan.
• Unrestricted driver's license to fulfill driving responsibilities.
• High School Diploma or equivalent.
• Proficiency in Google Suite or MS Office.

Nice to have

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

Culture & Benefits

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