Network Management Implementation Specialist

Jobtailor; Long Beach (CA); On-site; USD 90,000 - 130,000; Full time

Job summary

Jobtailor is seeking an experienced Provider Onboarding & Offboarding Manager in California to coordinate end-to-end onboarding, offboarding, and regulatory compliance across cross-functional teams. You will develop workflows, manage risks, and ensure accurate data handling throughout the provider lifecycle.

The role requires 3–5 years in provider network management or healthcare operations, with strong communication skills and proficiency in Microsoft Office and Visio.

Qualifications

• 3-5 years of experience in provider network management, healthcare operations, or implementation roles with cross-functional collaboration.
• At least 3 years’ experience in provider onboarding and direct provider engagement, including presentations and discussions on workflows and compliance.
• Solid understanding of Medicare Advantage operations and provider-facing processes.
• Bachelor's Degree or equivalent; advanced degree preferred.
• Proficiency in Microsoft Office tools (Word, Excel, Outlook, Teams, PowerPoint, Visio).

Responsibilities

• Coordinate end-to-end provider onboarding and offboarding management across cross-functional teams.
• Ensure compliant member communication and data handling during onboarding and offboarding.
• Develop, implement, and maintain standardized workflows, procedures, and timelines.
• Collaborate with Network Training and Compliance teams to meet regulatory standards.
• Monitor milestones, identify risks, and coordinate resolutions to maintain operational readiness.
• Represent Network Management in governance meetings and provide SME input on provider implementation.
• Promote CMS, DMHC, DHCS, and NCQA compliance through accurate documentation and lifecycle tracking.
• Support system modernization by capturing requirements and testing enhancements.

Skills

Provider Network Management

Project Management

Workflow Development

Data Integrity

Risk Management

Education

Bachelor's Degree or equivalent

Graduate or Advanced Degree or equivalent

Tools

Microsoft Office

Visio

Job description

• Coordinate end-to-end provider onboarding and offboarding management: Project manage all cross-functional tasks and deliverables associated with the provider onboarding, including pre-delegation audits, roster loading and display, MFT setup, claims payment configuration, and reporting activation to ensure seamless onboarding experiences.
• Manage provider offboarding processes: Ensure smooth offboarding when a provider terminates or changes MSO affiliation by coordinating member reassignment, provider data removal, report deactivation, and compliant member communication in partnership with internal teams.
• Develop and maintain workflows and documentation: Design, implement, and regularly update standardized workflows, procedures, and timelines to support consistent practices, operational readiness, and data integrity throughout the full provider lifecycle.
• Ensure clear operational handoffs across departments and adherence to established timelines for onboarding and offboarding activities.
• Collaborate with Network Training and Compliance teams: Partner with the Network Training Specialist for all education and training needs, and work with the Compliance team to confirm all policies, desktop procedures, and materials associated to provider onboarding and offboarding comply with regulatory and organizational standards.
• Monitor project milestones and risk management: Track and analyze project deliverables, identify risks or process gaps, and coordinate timely resolutions with business partners to maintain accuracy and efficiency across operational readiness for provider onboarding and offboarding.
• Serve as subject matter expert and liaison: Represent Network Management in cross-functional meetings and governance committees related to provider onboarding and offboarding, providing insight and expertise on provider implementation, configuration readiness, and operational optimization.
• Ensure regulatory and audit readiness: Promote compliance and adherence to CMS, DMHC, DHCS, and NCQA requirements through accurate documentation, lifecycle tracking, and post-termination data closure activities to maintain audit preparedness and meet quality standards.
• Facilitate provider communications, education, and presentations: Collaborate with Network Training and Communications teams to enhance provider onboarding materials, orientation tools, and outreach initiatives enhancing provider understanding and engagement.
• Conduct provider presentations and engage directly with provider partners to ensure clarity around onboarding expectations, operational workflows, and ongoing requirements.
• Drive continuous process improvement: Identify and implement enhancements to workflows, tools, templates, and reporting processes that increase efficiency, accuracy, and provider satisfaction throughout the lifecycle.
• Support system modernization and integration efforts: Contribute to SCAN’s system improvement and migration projects by capturing business requirements, testing enhancements, validating changes, and supporting implementation during and after release.

Requirements

• 3-5 years' experience in provider network management, healthcare operations, or implementation roles requiring cross-functional collaboration, process coordination, and strong communication skills.
• At least 3 years’ experience in provider onboarding and direct provider engagement, including delivering presentations and facilitating discussions on operational workflows, onboarding expectations, and compliance requirements.
• Must demonstrate a solid understanding of Medicare Advantage operations and provider-facing processes.
• Bachelor's Degree or equivalent experience required.
• Graduate or Advanced Degree or equivalent experience preferred.
• Skilled in Microsoft Office (Word, Excel, Outlook, Teams, PowerPoint, Visio).

Core Competencies

Demonstrates expertise in provider onboarding and offboarding management, ensuring compliance with regulatory standards while enhancing operational workflows and communication strategies. Proficient in project management and process improvement to drive efficiency and provider satisfaction throughout the provider lifecycle.

Highest-signal resume keywords

• Provider Onboarding Management
• Healthcare Operations
• Medicare Advantage Operations
• Cross-Functional Collaboration
• Process Improvement

ATS Optimization Keywords

Hard Skills

• Provider Network Management
• Project Management
• Workflow Development
• Data Integrity
• Risk Management

Soft Skills

• Strong Communication Skills
• Collaboration
• Facilitation
• Presentation Skills

Industry Keywords

• CMS Compliance
• DMHC
• DHCS
• NCQA
• Operational Readiness

Tools & Technologies

• Microsoft Office
• Visio