Job Summary:The Manager of Provider Network Management manages the day-to-day activities of the Provider Network Management department and its staff. This position assists leadership with departmental activities related to provider satisfaction, education, and communication. The Manager is also responsible for provider network recruitment, contracting, and management activities. This role ensures the department and staff remain current and compliant with applicable federal and state rules, regulations, policies, and procedures. The Manager creates or modifies departmental policies as needed to reflect regulatory and operational changes and supports the achievement of annual departmental goals and objectives.
Responsibilities:- Assist leadership with driving provider network management strategy.
- Assist leadership with departmental activities related to provider satisfaction, education, and communication.
- Assist in the development and execution of the annual provider network strategy, including network adequacy standards and the development of a marketable provider network.
- Implement and oversee market strategies.
- Make staffing decisions and manage the day-to-day activities of Account Executives, Quality Practice Advisors, and Provider Network Coordinators.
- Assist department leadership in ensuring staff remain compliant with applicable federal and state rules, regulations, policies, and procedures. Create or modify departmental policies as needed to reflect changes.
- Oversee and facilitate the resolution of provider disputes.
- Oversee training and communication for network providers and serve as a liaison with the provider community.
- Establish priorities for new geographic locations and provider types to be added to the Plan's network in alignment with other Plan departments.
- Partner with Plan departments to retain network providers who are at risk for termination. Develop and execute plans for large-scale provider terminations.
- Participate in Plan and physician committees, as appropriate.
- As applicable, provide strategic planning for facility and physician network value-based contracting development and management.
- As applicable, assist territory Account Executives with planning, implementing, and monitoring value-based programs.
- Monitor and manage the provider network to ensure appropriate access to services throughout the Plan's territory.
- Develop and assist with the development of provider training and communications.
- Maintain general operational knowledge related to provider satisfaction, education, and communication.
- Support value-based contract negotiations and serve as the lead negotiator when needed.
Education & Qualifications- Bachelor's degree required. Degree in business, healthcare administration, healthcare management, another health-related discipline, or an equivalent field preferred.
- Experience in managed care required. Medicare, Medicaid, and/or Health Insurance Marketplace/Exchange experience preferred.
- Minimum of 5 years of provider network management, contracting, reimbursement, or other related experience required.
- Minimum of 3 years of supervisory, management, or leadership experience preferred, preferably within a managed care organization.
- Strong verbal and written communication skills, with the ability to communicate effectively with leadership, team members, providers, and other key stakeholders.
Work Arrangement: Remote: The candidate must reside in South Carolina and possess a valid driver's license.
Our Comprehensive Benefits Package: Flexible work solutions include remote options, hybrid work schedules, competitive pay, paid time off, holidays and volunteer events, health insurance coverage for you and your dependents starting Day 1, 401(k) retirement savings plan, tuition reimbursement, and more.
