Provider Network Manager

📋 Description

• Development, upkeep, and administration of a robust provider network within the designated geographical region.

• Cultivating relationships and managing all provider relations activities in the assigned area, which includes negotiating and re-negotiating contracts with providers as needed.

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

• Overseeing various reports to ensure all necessary compliance requirements are fulfilled and maintained.

• Providing regular updates to leadership regarding current status, risks, and potential opportunities within the area of responsibility.

• Assisting the overall Network Team as needed to ensure the success of 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 directly working with practices to establish workflows and best practices that enhance quality outcomes, member satisfaction, preventive care compliance, and clinical documentation accuracy.

• Employing performance dashboards and reporting tools to monitor STAR measure performance, HEDIS metrics, and other quality indicators, proactively reaching out to providers whose performance is below targets and collaborating on action plans for improvement.

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

⛳️ Requirements

• Over 5 years of experience negotiating provider contracts, including physician/provider group contracts with various payment methodologies, including value-based/risk.

• Experience in provider servicing.

• Strong proficiency in navigating either Google Suite or Microsoft Suite products.

• Minimum of a High School Diploma or equivalent.

• Familiarity with CMS STAR measures.

• Established relationships and experience within the local market.

• Unrestricted driver's license to confirm your ability to meet the driving responsibilities associated with the role.

🏝️ Benefits

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

• Generous paid time off.

• $100 monthly stipend for mobile or internet expenses.

• Stock options available for all employees.

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

• Parental leave program.

• 401K program.

• And more....