Manager - Network Quality and Management

About the role

The Manager of Network Quality & Management leads a dedicated team responsible for establishing and maintaining relationships with clinicians, hospitals, and healthcare providers while ensuring clinical quality standards, regulatory compliance, and continuous performance improvement across the provider network. The clinical strategy and oversight are provided by the Manager, who serves as a clinical leader and strategic advisor. Routine provider relations and operational tasks are executed by non-clinical provider relations associates under the Director's clinical guidance. This position leverages clinical expertise to oversee quality initiatives, establish clinical performance benchmarks, credential clinical providers, and guide both clinical and administrative staff to achieve high standards of clinical care and network performance. This is a fast-paced, multifaceted role requiring clinical judgment, strong communication with clinicians, and the ability to manage competing priorities across quality improvement, network development, and regulatory compliance. The Manager will spend significant time building trust-based relationships with clinicians and clinical leaders directly, both virtually and in person, while leveraging clinical expertise, quality data, and performance analytics to identify opportunities for clinical excellence, network expansion, and strategic partnerships. Reports to: VP of Network Management and Strategy. This position offers remote work flexibility while requiring travel within the service area as needed (minimum 25% travel expected for provider meetings and in-person visits). The role operates in a fast-paced, dynamic environment requiring strong attention to detail and excellent multitasking abilities.

Responsibilities

• Develop and implement quality standards and network management strategies that drive clinician engagement, network growth, and retention across current and prospective service areas
• Build and maintain trust-based relationships with clinicians, clinical leaders, and healthcare providers; serve as a liaison to understand practice patterns, clinical concerns, and needs
• Partner with clinicians and clinical leaders to establish clinical quality improvement initiatives, benchmark clinical performance against best practices and standards, and identify gaps in clinical capabilities or service offerings
• Conduct regular onsite clinical assessments with providers, utilizing clinical expertise and performance data to determine priority visits based on quality metrics, clinical outcomes, utilization patterns, member experience, and regulatory compliance indicators
• Represent the organization as a clinical subject matter expert in provider meetings, regulatory forums, clinical conferences, and key healthcare events; position the organization for network expansion into new