Network Management Specialist

This is a fully remote position, open to applicants in Texas.

📋 Description

• Monitor specialist coverage requirements by market, program, and specialty; identify priority gaps; research suitable practices; and execute outbound calls, emails, and follow-ups.

• Assess providers for Medicare and Medi-Cal/Denti-Cal enrollment, accessibility, service area, capabilities, and their willingness to serve Seniors and Adults with Special Needs.

• Keep up-to-date provider records, outreach history, pipeline status, ownership details, next actions, and follow-up dates.

• Manage contracting and credentialing information, NDA and fee schedule processes, handoffs, and visibility of status.

• Oversee referral processes and track volume, turnaround time, completion rates, aging, cost issues, and unresolved exceptions.

• Facilitate provider onboarding readiness, credentialing status, referral workflow education, portal access, training, billing setup, communication expectations, and clinical training.

• Provide operational oversight of internal specialists in collaboration with regional and clinical leadership.

• Act as the main operational contact for specialist practices post-onboarding and ensure follow-through on provider concerns.

• Organize provider-facing follow-up regarding invoicing or payment issues and monitor internal resolution with Accounts Payable.

• Track provider activity, referral acceptance, response times, workflow compliance, inactivity, and relationship risks; assist with re-engagement, corrective measures, or offboarding.

• Maintain network rosters, report on coverage and pipeline health, identify stalled tasks and recurring challenges, and aid in evaluating and implementing centralized tracking.

• Collaborate with Clinical Operations, Clinical Excellence Committee, Contracting, Credentialing, Billing, Account Management/Client Engagement, Market Directors, Clinical Team Managers, Referral Specialists, and PACE program teams.

• Manage KPIs related to network gaps, outreach, recruitment pipeline, contracting/credentialing/onboarding visibility, referral performance, provider utilization, specialist operations, payment issues, and relationship health.

⛳️ Requirements

• Minimum of two years of experience in healthcare operations, provider relations, network development, referral coordination, provider recruitment, sales, credentialing support, or a similar field.

• Excellent organizational skills and follow-through across various providers, markets, priorities, and deadlines.

• Strong written and verbal communication skills that are clear and professional.

• Comfortable with outbound provider outreach and relationship-focused follow-up.

• Capability to build relationships, articulate value, and influence prospective providers through outreach and recruitment efforts.

• Experience in maintaining accurate records in a CRM, workflow platform, or complex operational tracker.

• Ability to coordinate tasks across multiple teams while keeping status, ownership, next steps, and escalations visible.

• Strong judgment skills and attention to detail.

• Ability to identify missing information, stalled work, recurring obstacles, and operational risks.

• Capability to work independently within established guidelines and appropriately escalate clinical, contracting, credentialing, or fee-related decisions.

• Ability to manage sensitive healthcare and business information while adhering to privacy and compliance regulations.

• Preferred: experience with PACE, Medicare, Medi-Cal/Denti-Cal, dental services, specialist networks, provider contracting, credentialing, onboarding, referral workflows, CRM or healthcare referral platforms, provider portals, utilization, network coverage, referral performance, operational KPIs, or providers serving Seniors and Adults with Special Needs.

• Reliable, high-speed internet access is required.

🏝️ Benefits

• Base salary ranging from $70k–80k, commensurate with experience.

• No bonus structure.

• Flexible scheduling based on provider availability, program requirements, and occasional meetings across various time zones.

• Opportunity for remote work.

• Occasional travel may be required based on business needs.