Program Manager II – Provider Network

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

📋 Description

• Perform both routine and ad hoc analyses of the provider network based on geography, specialty, and business line.

• Oversee the performance of network adequacy and pinpoint any gaps or access-related challenges.

• Facilitate monthly and quarterly Network Adequacy Committee meetings while developing relevant reporting materials.

• Oversee efforts to remediate network gaps by collaborating with teams in Contracting, Provider Data Operations, Provider Engagement, Credentialing, Compliance, and Network Operations.

• Generate network adequacy reports for internal leadership and regulatory compliance.

• Assist with the annual exception request processes for Medicaid and Medicare network adequacy when necessary.

• Conduct impact analyses related to provider networks in the context of contract negotiations, terminations, and network strategy initiatives.

• Develop, sustain, and enhance reporting tools, dashboards, trackers, business documentation, and workflow processes.

• Coordinate cross-functional workgroups and ensure the follow-up on action items until completion.

• Act as a subject matter expert on provider network composition, access, adequacy, and reporting.

• Carry out other assigned duties as needed.

• Adhere to all policies and standards.

⛳️ Requirements

• Must have authorization to work in the U.S. without the necessity of employment-based visa sponsorship, now or in the future.

• A Bachelor's Degree in a related field or equivalent experience is required.

• Minimum of 3 years of experience in quality improvement, program management, or project management is essential.

• Background in healthcare network operations, provider contracting, network adequacy, provider data management, or managed care organizations is needed.

• Strong analytical and problem-solving abilities with experience in interpreting large data sets and converting findings into actionable insights.

• Advanced skills in Excel and reporting, including the use of pivot tables, lookups, data validation, and automation of reports.

• Familiarity with Power BI, reporting tools, or business intelligence platforms is required.

• Excellent project management and organizational abilities, with the capacity to juggle multiple priorities concurrently.

• Proven experience in facilitating meetings and leading cross-functional teams.

• Outstanding written and verbal communication skills.

• Competence in presenting data and recommendations to leaders and business stakeholders.

• Preferred knowledge of Medicaid, Medicare Advantage, and Commercial network requirements.

• Strong preference for experience in healthcare regulatory reporting, network adequacy standards, or provider network access analysis.

• Prior healthcare experience is preferred.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement program.

• Paid time off in addition to holidays.

• Flexible work arrangements including remote, hybrid, field, or office-based schedules.

• Additional incentive programs may be included in total compensation.

• Equal opportunity employer dedicated to promoting diversity.