Sr. Managed Care Network Manager
New
Based in United StatesFull-TimeSenior
Salary66,170.74 - 123,073.07 USD per year
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Job Details
- Experience
- 7+ years
- Required Skills
- Microsoft AccessMicrosoft ExcelChange Management
Requirements
- Bachelor’s degree in Healthcare, Business, or a related field (Master’s preferred).
- 7+ years of experience in healthcare, insurance, provider relations, or managed care environments.
- Strong experience in provider network management, contract negotiation, and contract administration.
- Solid understanding of medical terminology, CPT coding, and reimbursement methodologies.
- Proven ability to negotiate and manage complex payer contracts and amendments.
- Experience working with provider groups, health plans, and healthcare delivery systems.
- Strong analytical, organizational, and problem-solving skills with the ability to manage multiple priorities.
- Excellent verbal and written communication skills with the ability to engage clinical, administrative, and executive stakeholders.
- Proficiency in Microsoft Office Suite, including Excel and Access, with strong overall computer literacy.
- Ability to work independently in a remote environment while managing deadlines and variable schedules.
Responsibilities
- Coordinate and implement managed care plans by working closely with internal teams, provider groups, and external health plan partners to ensure effective execution of network strategies.
- Lead provider group transitions, including acquired and affiliated organizations, ensuring smooth onboarding and alignment with managed care requirements.
- Develop and maintain strong relationships with managed care plans through consistent communication, negotiation, and partnership management.
- Negotiate contract terms, amendments, and agreements with payers to achieve favorable reimbursement and operational outcomes.
- Monitor managed care plan performance to ensure compliance, efficiency, and alignment with organizational objectives.
- Support resolution of escalated issues, claims payment challenges, and operational concerns related to managed care contracts.
- Coordinate provider credentialing processes for affiliated and acquired groups within managed care networks.
- Facilitate training and education for provider leadership on managed care policies, procedures, and requirements.
- Collaborate with stakeholders to address clinical, operational, and claims-related issues and ensure timely resolution.
- Contribute to continuous improvement initiatives aimed at enhancing managed care operations and network effectiveness.
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