Provider Network Manager

About the role

This is a key role in our organization. This role will require a strong understanding of Medicare Advantage quality programs, including CMS STAR measures, with the ability to work collaboratively with providers to identify and close clinical care gaps, improve quality performance, and support initiatives that enhance member outcomes and overall plan performance. Additionally, this role will be responsible for network development and management along with servicing for an assigned geographic area.

Responsibilities & Impact

Development, maintenance and management of an adequate provider network in assigned geographical area
Maintaining relationships and all provider relations activities in assigned geographical area, including negotiating and renegotiating contracts with providers as assigned
Engage internal subject matter experts and providers to identify opportunities to improve provider/member cost and quality performance
Monitoring of various reports to insure all necessary compliance requirements are met and maintained
Reporting to leadership current status, risks, and potential opportunities in area of responsibility on a regular basis
Supporting the overall Network Team as required to achieve success for Devoted Health
Supporting assigned groups to improve performance in CMS STAR measures, including educating providers and their staff on STAR measure requirements, identifying performance gaps through data analysis, coordinating with internal quality teams to implement improvement initiatives, reviewing provider-level performance reports, and working directly with practices to implement workflows and best practices that improve quality outcomes, member satisfaction, preventive care compliance, and clinical documentation accuracy
Utilizing performance dashboards and reporting tools to track STAR measure performance, HEDIS metrics, and other quality indicators, proactively engaging providers whose performance falls below targets and collaborating on action plans to improve results
Partnering with internal quality, clinical, and analytics teams to interpret STAR performance reports and translate insights into actionable strategies for providers, ensuring alignment with organizational goals and CMS quality improvement priorities

Requirements

5+ years negotiating provider contracts including physician/provider group contracts with multiple payment methodologies including value based/risk
Provider servicing experience
Solid ability to navigate either Google or MS Suite of products
High School Diploma or equivalent minimum
Experience in CMS STAR measures
Experience and relationships in the local market
Unrestricted driver's license to verify your eligibility and capability to fulfill the driving responsibilities associated with the position

Qualifications

Ability to make quick, independent decisions
Mutually beneficial negotiation skills
Strong project management skills
Attention to detail
Ability to analyze financial and performance reports and identify trends/variances
“Understanding impacts of decisions on network as a whole
Extremely effective oral/written communication skills

Skills

Desired skills and experience: Ability to make quick, independent decisions
Mutually beneficial negotiation skills
Strong project management skills
Attention to detail
Ability to analyze financial and performance reports and identify trends/variances
“Understanding impacts of decisions on network as a whole
Extremely effective oral/written communication skills

Benefits

Salary: $80,000 - $110,000 / year

Pay

The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Total Rewards

Our Total Rewards package includes: - Employer sponsored health, dental and vision plan with low or no premium - Generous paid time off - $100 monthly mobile or internet stipend - Stock options for all employees - Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles - Parental leave program - 401K program - And more....