Provider Network Manager

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

📋 Description

• Negotiate agreements with healthcare providers and essential vendors in designated markets to create competitive and cost-effective healthcare provider networks that comply with CMS network adequacy standards.

• Ensure that providers and essential vendors fulfill credentialing requirements.

• Continuously analyze the Health Plan(s) provider network to uphold network adequacy.

• Assist in the rollout of Health Plan(s) in new markets as required.

• Foster a supportive work environment that promotes process improvement and dedication to departmental and company success.

• Complete corporate tasks, including compliance training, as assigned.

• Maintain positive professional relationships with contracted providers.

• Report significant changes in assigned markets.

• Act as a subject matter expert for other departments within the organization.

⛳️ Requirements

• Must possess knowledge and familiarity with all levels of medical services and the ability to quickly establish working relationships.

• Must be capable of accepting directions and working independently to achieve goals and complete assignments.

• Must demonstrate strong negotiation, organizational, presentation, and time management skills.

• Must effectively communicate with medical staff to articulate the Health Plan(s) program, benefits, and objectives.

• Must be able to collaborate effectively within a team environment.

• Excellent computer skills, including proficiency in Microsoft Office Suite.

• Must be self-motivated, reliable, and oriented towards teamwork and goals.

• Successful completion of required training is necessary.

• Ability to manage multiple priorities effectively.

• Capable of independent decision-making and discretion.

• Reliable transportation is required.

• Current automobile insurance in accordance with company policy is necessary.

• Bachelor’s degree or equivalent work experience is required.

• A minimum of five (5) years of experience in managed care, network development, or network services.

• Experience in the healthcare field is mandatory.

• Prior experience with Medicare Advantage plans is advantageous.

• Prior experience in network development or network services is essential.

• Experience with acute and post-acute facilities is a plus.

• Must be available to work from 8 a.m. to 5 p.m. local time.

• Position requires occasional travel to network provider locations.

🏝️ Benefits

• Affordable medical, dental, and vision insurance options.

• Generous paid time-off program along with paid holidays for full-time staff.

• 24/7/365 access to doctors through TeleDoc.

• Optional short- and long-term disability plans.

• Employee Assistance Plan (EAP).

• 401K retirement accounts with company matching.

• Employee Referral Bonus Program.

• Teleworking is available if criteria are met.