Provider Network Manager

This is a fully remote position, open to applicants in Ohio, +1 more state.

📋 Description

• Development, upkeep, and management of a suitable provider network within the designated geographical area.

• Maintaining relationships and overseeing all provider relations activities in the assigned geographical area, which includes negotiating and renegotiating contracts with providers as necessary.

• Collaborating with internal subject matter experts and providers to discover opportunities for enhancing provider/member cost and quality performance.

• Monitoring various reports to ensure all essential compliance requirements are fulfilled and sustained.

• Regularly reporting to leadership on the current status, risks, and potential opportunities within the area of responsibility.

• Assisting the overall Network Team as needed to achieve success for Devoted Health.

• Aiding assigned groups in enhancing performance in CMS STAR measures, which involves educating providers and their staff on STAR measure requirements, identifying performance gaps through data analysis, coordinating with internal quality teams to implement improvement initiatives, reviewing provider-level performance reports, and working directly with practices to establish workflows and best practices that enhance quality outcomes, member satisfaction, preventive care compliance, and clinical documentation accuracy.

• Utilizing performance dashboards and reporting tools to monitor STAR measure performance, HEDIS metrics, and other quality indicators, proactively engaging providers whose performance is below target and collaborating on action plans to enhance results.

• Partnering with internal quality, clinical, and analytics teams to interpret STAR performance reports and translate insights into actionable strategies for providers, ensuring alignment with organizational objectives and CMS quality improvement priorities.

⛳️ Requirements

• Over 5 years of experience in negotiating provider contracts, including contracts with physician/provider groups that utilize multiple payment methodologies, including value-based and risk-based models.

• Experience in provider servicing.

• Strong proficiency in navigating either Google Suite or MS Suite of products.

• Minimum of a High School Diploma or equivalent.

• Familiarity with CMS STAR measures.

• Established experience and relationships within the local market.

• Unrestricted driver's license to confirm eligibility and capability to fulfill the driving responsibilities associated with the role.

🏝️ Benefits

• Employer-sponsored health, dental, and vision plans with low or no premium.

• Generous paid time off.

• Monthly stipend of $100 for mobile or internet expenses.

• Stock options available for all employees.

• Bonus eligibility for all roles except for Director and above; commission eligibility for Sales roles.

• Parental leave program.

• 401K program.

• And more....