Provider Network Performance Manager

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

📋 Description

• Drive provider performance across cost, quality, access, and key network metrics.

• Identify performance gaps, root causes, and areas for enhancement.

• Develop and implement targeted plans for provider performance improvement.

• Monitor outcomes and adapt strategies to ensure ongoing improvement.

• Act as a primary performance partner for designated physicians, medical groups, health systems, and other providers.

• Lead regular provider performance assessments and Joint Operating Committees (JOCs).

• Foster strong provider relationships while establishing accountability for performance expectations and results.

• Collaborate with providers to address performance challenges and eliminate barriers to improvement.

• Analyze financial, operational, quality, and provider performance data.

• Utilize reporting systems, dashboards, and AI-enabled tools to derive insights.

• Convert complex data into clear recommendations and actionable plans.

• Provide leadership with insights into performance trends, risks, and opportunities.

• Assist in contract negotiations and renegotiations as necessary.

• Apply fee-for-service, value-based, and risk-based models to facilitate improvements in cost and quality.

• Assess provider and network opportunities through a performance-focused lens.

• Collaborate across functions to enhance network efficiency, quality, access, and regulatory compliance.

• Travel approximately 30–40% within the assigned market for provider meetings, relationship development, and market presence.

⛳️ Requirements

• Must reside in New Jersey.

• Over 5 years of experience in managed care, a health plan, or a comparable healthcare setting.

• More than 5 years of direct experience interacting with providers.

• Proven track record of enhancing provider performance across cost and/or quality metrics.

• Strong analytical abilities with a talent for translating data into actionable insights.

• Excellent provider relationship management, communication, and influencing skills.

• Capability to work independently, resolve intricate problems, and achieve results.

• Experience in negotiating provider contracts, including with physician groups and/or health systems.

• Familiarity with value-based or risk-based payment models.

• Background in provider performance, network optimization, or healthcare analytics.

• Willingness to travel approximately 30–40% within the designated market.

🏝️ Benefits

• Employer-sponsored health, dental, and vision plan with minimal 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 positions excluding Director and above.

• 401K program.

• Parental leave program.

• Comprehensive rewards package for full-time employees.