Manager Provider Network Management

PROTECTHEALTH CORPORATION SDN. BHD.; Cyberjaya; On-site; MYR 180,000 - 240,000; Full time

Job summary

ProtectHealth Corporation Sdn Bhd is seeking a Manager, Provider Network Management to oversee day-to-day operations, performance and governance of ProtectHealth’s healthcare provider network. The role ensures efficient, compliant processes and strong provider relationships across the provider lifecycle.

You will lead empanelment, credentialing and contract management, monitor KPIs and cost-containment initiatives, and coach a multidisciplinary team, contributing to high-quality care outcomes.

Qualifications

• Bachelor’s Degree in Healthcare Management, Medicine, Pharmacy, Nursing, Allied Health, Business Administration, Health Administration or related discipline.
• 7–10 years of relevant healthcare industry experience, preferably within hospitals, health insurance, managed care, TPA or provider network management.
• Strong experience in healthcare provider/panel network management.
• Experience in provider empanelment, contracting, performance management and relationship management.
• Exposure to healthcare cost containment and/or FWA.
• Experience in commercial negotiation and contract management would be highly advantageous.
• Previous experience supervising a team or leading healthcare operational projects.
• Strong analytical, stakeholder management, problem-solving and communication skills.
• Exposure to patient/care outcome management or analysis would be an added advantage.

Responsibilities

• Manage the end-to-end provider lifecycle, including empanelment, credentialing, onboarding, renewal, suspension and termination.
• Monitor provider performance against KPIs, SLAs, contractual requirements and service standards.
• Manage provider performance reviews, improvement plans and operational escalations.
• Build and maintain strong relationships with healthcare providers and relevant stakeholders.
• Support commercial negotiations, contract management and provider renewals.
• Drive and monitor healthcare cost-containment initiatives.
• Support the identification and management of Fraud, Waste & Abuse (FWA).
• Collaborate with Analytics and relevant teams to review provider utilisation, costs, performance and care outcome information.
• Ensure provider activities comply with organisational policies, contractual obligations and applicable regulatory requirements.
• Identify opportunities for process improvement, operational efficiency and digitalisation.
• Supervise, coach and develop team members within Provider Network Management.

Skills

Analytical skills

Stakeholder management

Problem-solving

Communication skills

Healthcare industry knowledge

Education

Bachelor’s Degree in Healthcare Management or related

Job description

About the role

The Manager, Provider Network Management is responsible for managing the day-to-day operations, performance and governance of ProtectHealth’s healthcare provider network. The role oversees key activities across the provider lifecycle, strengthens provider relationships, monitors service and contractual performance, and supports cost containment, care outcomes and Fraud, Waste & Abuse (FWA) initiatives.

Working closely with the Head of Section and cross-functional teams, the Manager will play an important role in ensuring an efficient, compliant and high-performing provider network.

Key responsibilities

• Manage the end-to-end provider lifecycle, including empanelment, credentialing, onboarding, renewal, suspension and termination.
• Monitor provider performance against KPIs, SLAs, contractual requirements and service standards.
• Manage provider performance reviews, improvement plans and operational escalations.
• Build and maintain strong relationships with healthcare providers and relevant stakeholders.
• Support commercial negotiations, contract management and provider renewals.
• Drive and monitor healthcare cost-containment initiatives.
• Support the identification and management of Fraud, Waste & Abuse (FWA).
• Collaborate with Analytics and relevant teams to review provider utilisation, costs, performance and care outcome information.
• Ensure provider activities comply with organisational policies, contractual obligations and applicable regulatory requirements.
• Identify opportunities for process improvement, operational efficiency and digitalisation.
• Supervise, coach and develop team members within Provider Network Management.

What we're looking for

• Bachelor’s Degree in Healthcare Management, Medicine, Pharmacy, Nursing, Allied Health, Business Administration, Health Administration or a related discipline.
• Approximately 7–10 years of relevant healthcare industry experience, preferably within hospitals, health insurance, managed care, TPA or provider network management.
• Strong experience in healthcare provider/panel network management.
• Experience in provider empanelment, contracting, performance management and relationship management.
• Exposure to healthcare cost containment and/or FWA.
• Experience in commercial negotiation and contract management would be highly advantageous.
• Previous experience supervising a team or leading healthcare operational projects.
• Strong analytical, stakeholder management, problem-solving and communication skills.
• Exposure to patient/care outcome management or analysis would be an added advantage.

Incorporated on 19 December 2016, ProtectHealth Corporation Sdn Bhd (ProtectHealth) is a wholly‑owned subsidiary of ProtectHealth Malaysia, established under the Ministry of Health, Malaysia (MOH).

As a not‑for‑profit company, ProtectHealth coordinates, administers and manages initiatives related to financing healthcare services as mandated by MOH.