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About the role
Key responsibilities & impact- Provide operational oversight of the Provider Network to ensure effective, compliant, and high-quality service delivery.
- Lead, direct, and manage Provider Network Supervisors, overseeing workflows, performance metrics, and service quality.
- Provide guidance and direction on escalated cases.
- Handle escalated provider and client complaints, claims, authorization issues, and complex problem resolution matters.
- Lead recurring operational meetings to review escalated cases, analyze data trends, and address matters requiring higher visibility.
- Develop, implement, and maintain Standard Operating Procedures (SOPs) and workflows to meet or exceed established Service Level Agreements (SLAs) and performance metrics.
- Monitor counseling quality metrics, client feedback scores, and provider performance measures; develop and maintain provider scorecards to ensure consistent service quality.
- Utilize tools such as MS Office applications and EHR systems to analyze performance data and provide recurring metric reports.
- Track provider referral volumes to identify high-performing providers eligible for incentives, low- or no-volume providers, and providers requiring corrective action or removal from the roster.
- Ensure timely and accurate completion of provider documentation.
- Engage with provider network subcontractors to address performance concerns, contractual issues, and service improvements.
- Mentor and provide supplemental training to Provider Network Supervisors to strengthen leadership and operational effectiveness.
- Escalate high-visibility events and maintain required Quality Assurance (QA) and Quality Control (QC) documentation.
- Foster collaborative relationships with subcontractors and program leadership to promote alignment, communication, and a high-performing team culture.
- Perform additional duties and special projects as assigned based on business needs.
Requirements
What you’ll need- Bachelors’ degree from an accredited university
- 5+ years progressive experience working directly with provider relations network specific to behavioral health
- Experience with network provider recruitment, network gap analysis, provider credentialing and onboarding experience
- Experience working closely with subcontractors in a management role
- Minimum of five years of supervisory or people management experience in a similar program environment
- Strong project management skills with demonstrated ability to deliver services within established timelines, budget parameters, and quality standards
- Strong customer service skills and demonstrated knowledge of call center operations
- Ability to build strong customer relationships and deliver solutions
- Proficiency in Microsoft Office applications including Word, Outlook, Excel, as well as web-based research and electronic documentation systems.
- Strong analytical, organizational, and leadership skills.
- U.S. citizenship and fluency in English required.
- Ability to successfully pass criminal history, fingerprint background checks, and credential verification required.
Benefits
Comp & perks- Health and Wellness programs
- Income Protection
- Paid Leave
- Retirement
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
provider network managementprovider recruitmentnetwork gap analysisprovider credentialingonboardingproject managementdata analysisquality assurancequality controlperformance metrics
Soft Skills
leadershipcustomer serviceanalytical skillsorganizational skillsproblem resolutioncommunicationmentoringcollaborationrelationship buildingtraining