Salary
💰 $100,000 - $120,000 per year
About the role
- Oversee a diverse portfolio of leased carrier networks and COE partners, managing ongoing performance and operational relationships
- Drive network performance excellence by reporting on KPIs including performance guarantees, client and membership growth, network revenue, product utilization, and quality outcomes
- Develop performance dashboards that deliver actionable insights for leadership and client account teams
- Maintain operational oversight: develop network management documentation, prepare internal updates, manage contracts, and serve as primary contact for operational issues and processes
- Monitor compliance: track performance guarantees, ensure accurate delivery of network scorecards, and review data for compliance with membership growth targets and claims timeliness
- Resolve complex escalations: lead research and resolution of service requests and complex client escalations related to network issues, collaborating with networks on training coordination
- Support strategic initiatives and GTM new network implementation with project management expertise and operational readiness coordination
- Enable internal teams by supporting Claims Operations, Clinical teams, and Commercial teams with operational and contractual clarity
- Organize network notification processes and contribute to the strategic development of network management capabilities
Requirements
- Bachelor's degree in Healthcare Administration, Business, or related field (equivalent work experience considered)
- 2-4 years experience in provider network management, provider relations, or healthcare operations
- Experience within TPA, health plan, or health system environment
- Demonstrated experience with different provider reimbursement models including fee-for-service
- Understanding of value-based care concepts (ACOs, Clinically Integrated Networks)
- Proven ability to analyze healthcare data (claims, provider, network, eligibility) to identify trends and solve problems
- Natural ability to build rapport and establish trust with clients, providers, and internal colleagues (relationship building)
- Strong problem-solving and analytical skills; ability to translate complex data into clear, actionable insights
- Outstanding organizational and project management skills; ability to manage multiple projects and competing priorities
- Exceptional written and verbal communication skills for presenting information clearly to diverse audiences
- Self-starter who can work independently, take ownership of projects, and navigate ambiguity in dynamic environments
- Proficient in Microsoft Office Suite (especially Excel) and comfortable learning new claims and provider management software