Senior Manager, Provider Relations

This is a fully remote position, open to applicants in New Jersey, +2 more states.

📋 Description

• Oversee a team of Provider Relations Representatives, Network Performance Advisors, and/or Provider Relations Supervisors.

• Manage the designated region and/or market territory.

• Cultivate the Provider Relations Team to meet market performance objectives.

• Execute and implement network transformation strategies aimed at enhancing overall network performance.

• Conduct field ride-alongs and offer timely constructive feedback through Field Trip Reports.

• Monitor provider performance action plans and assess improvements.

• Ensure adherence to provider performance and relationship models, as well as provider performance reporting.

• Collaborate with the Quality Team to enhance provider performance related to HEDIS and STARS measures.

• Organize and facilitate productive group meetings and discussions.

• Ensure compliance with contractual obligations and regulatory standards.

• Enhance Provider Satisfaction and overall Provider Experience.

• Monitor and develop High Performing Practices while driving Network Transformation Strategies to optimize member outcomes.

• Educate and strengthen provider partnerships and implement market and enterprise initiatives.

• Formulate strategies for membership growth in High Performing Practices and complex provider relationships.

• Train, mentor, and support new managers.

• Lead and develop the Provider Operations staff.

• Complete special projects as assigned or directed.

⛳️ Requirements

• Bachelor's Degree in a relevant field.

• 6+ years of experience in provider relations or a similar field.

• 3+ years of management experience.

• Equivalent work experience may be accepted in lieu of the required bachelor's degree.

• Knowledge of Risk and Value-Based contractual arrangements.

• Familiarity with HEDIS and STARS measures.

• Ability to ensure compliance with contractual obligations and regulatory requirements.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plans.

• Stock purchase plans.

• Tuition reimbursement programs.

• Paid time off along with holidays.

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

• Additional incentives may be included in total compensation.

• Equal opportunity employer dedicated to diversity.