Network Health WI

Medical Director

• Responsible for the administration of procedures, protocols, and standards regarding the efficiency and quality of the health care delivered to Network Health (NH) members
• Chair of at least 3 committees related to quality and accreditation
• Assist the CMO with monitoring availability, appropriateness, and necessity of care rendered by participating providers and by out-of-plan providers
• Participate in oversight and clinical decision making of the UM program, including rendering denial determinations for services not considered medically necessary or experimental/investigation/unproven in accordance with regulatory and quality standards
• Contribute to the development of quality care guidelines, internal peer review procedures, and the evaluation of medical care evaluation studies under the NHP quality assurance programs
• Provide medical consultation as requested for medical/legal issues, member grievance procedures, development and implementation of new benefit packages and the interpretation of covered benefits in NHP contracts, medical issues related to contract negotiations with health care providers
• Promote a positive relationship between NHP and the medical community
• Serve as liaison between NHP and providers regarding matters of medical policy and medical administration
• Perform second level review of provider appeals and disputes
• Assist in strategic planning targeted towards plan growth initiatives

Associate Medical Director

QA Engineer

• Collaborate in the planning, development, and deployment of new applications
• Build, coordinate and perform in-depth test plans, test cases and functional testing
• Maintain effective communication with software vendors
• Provide orientation and training to end users
• Support department leader by preparing and delivering reports, recommendations, or alternatives
• Establish, monitor, measure and report on key quality and productivity metrics
• Monitor productivity and efficiency of operations
• Coach and educate the team on best practices in configuration

IS Lead Configuration, Quality Assurance Analyst

• Monitoring and evaluating operational data to identify quality gaps
• Conducting internal audits
• Partnering with internal audit
• Identifying trends and root causes
• Recommending corrective actions

Enrollment Quality Assurance Analyst

Attorney

• Work closely with Network Health’s legal team conducting research on laws, statutes and regulations.
• Collaborate with our Appeals and Grievances team to help identify trends in Medicare Administrative Law Judge hearing outcomes.
• Partner with Human Resources to offer trainings and reminders on best practices regarding the FMLA, ADA, etc.
• Develop resources and conduct trainings on the Attorney-Client Privilege.
• Review vendor contracts and polish issue spotting skills under the supervision of in-house attorneys.
• Maintain all documents and information as strictly confidential.
• Perform all job duties in accordance with Network Health’s corporate values of Innovation, Service Excellence, Integrity, Collaboration, and Accountability.

Legal Intern – Summer 2026, Part-time

Manager

• Successfully manages the Managed Care Contracting prospective, renewal and termination negotiation processes as they relate to: Network Health, HMO/POS; third party administrators and self-funded employers, Accountable Care Organizations (ACO).
• Accountable for establishing and maintaining positive relationships with internal departments, Network Health executive leadership and for any of the following prospective and/or existing external group: Network Health HMO/POS and third-party administrators.
• Serves as the individual accountable for the overall relationship between Network Health and selected contracted providers.
• Specific duties include establishing the initial contact with contracted providers setting and/or maintaining the tone for the desired Network Health provider agreements.
• Conducts managed care contracting related research and analysis including developing compensation/reimbursement structures and contract terms/conditions.
• Evaluates best-fit options for continued negotiations.
• Prepare executive summaries and recommendations.
• Initiates contract implementation process.
• Maintains effective communication throughout contract terms and communicates contract updates and changes as needed.
• Requests audits from the Provider File Specialist and evaluates contracting terms.
• Provides leadership for department, and Network Health special projects

Associate Medical Director

IS Lead Configuration, Quality Assurance Analyst

Enrollment Quality Assurance Analyst

Legal Intern – Summer 2026, Part-time

Contract Manager