Network Management Lead

MCS Puerto Rico; San Juan (PR); On-site; USD 70,000 - 110,000; Full time

Job summary

MCS Puerto Rico is seeking a strategic Network Operations Leader to identify business needs, analyze data and market trends, and design plans aligned with organizational goals. The role coordinates health services network management locally and with international partners, focusing on service quality, process improvement, and contract compliance.

The position serves as a liaison among providers, delegated entities, and internal teams to ensure efficient network operations and end-to-end

Qualifications

• Bachelor’s degree in Business Administration, Finance, Accounting, or Health-related fields.
• At least five years of analytical experience in healthcare tariffs, network management, contract negotiation, and healthcare economics.
• Experience analyzing contracting models.

Responsibilities

• Leads cross-functional assessment processes to develop strategies aligned with organizational goals.
• Collects and analyzes data from multiple sources to support decision-making and reporting.
• Negotiates contractual agreements with vendors and providers, ensuring regulatory compliance as needed.
• Monitors progress of strategic initiatives from evaluation to implementation.
• Collaborates with internal teams to resolve health service issues and improve member satisfaction.

Skills

Analytical skills

Tariff analysis

Contract negotiation

Network management

Data interpretation

Education

Bachelor’s degree

Healthcare-related fields

Tools

Excel

SQL

SAS

Power BI

Job description

GENERAL DESCRIPTION:
Responsible for identifying a business's needs, data, and market trends to design plans that align with the organization's goals. Leads and coordinates effective strategies for health services network management at both local and international levels with a focus on service quality, process improvement, and contractual compliance. The position serves as a key liaison between providers, delegated entities, and internal teams to ensure efficient and strategic network operations.

Regular
Exempt

GENERAL DESCRIPTION

Responsible for identifying a business's needs, data, and market trends to design plans that align with the organization's goals. Leads and coordinates effective strategies for health services network management at both local and international levels with a focus on service quality, process improvement, and contractual compliance. The position serves as a key liaison between providers, delegated entities, and internal teams to ensure efficient and strategic network operations.

ESSENTIAL FUNCTIONS

• Leads internal cross-functional assessment processes and communicates with operational areas to develop effective strategies aligned with organizational goals.
• Collects, analyzes, and interprets detailed data from various sources to support decision-making and strategic reporting.
• Evaluates provider initiatives related to contracting, compensation, and corporate operations, providing recommendations based on analysis.
• Negotiates contractual agreements with vendors and providers, ensuring alignment with strategic objectives and regulatory compliance as needed.
• Monitors and documents the progress of strategic initiatives from evaluation through implementation.
• Reviews utilization and performance reports of providers and networks, contributing to action plans and continuous improvement efforts.
• Actively participates in meetings with internal departments, providers, clients, delegated entities, and vendors to communicate trends, projections, and strategic insights.
• Responsible for the end-to-end implementation of network strategies, including but not limited to: leading presentations for internal and external clients, prospects, providers, and vendors, managing the request for proposals processes, and special projects.
• Monitors the performance of network management vendors and delegated functions with entities through operational and financial indicators, leading performance discussions and corrective action plans, as applicable.
• Collaborates with internal teams to ensure timely resolution of health service issues, quality improvements, and member satisfaction.
• Provides relevant insights and data on delegated entities to support the business in achieving its objectives and goals.
• Leads the relationship with the United States-based network vendors, among others, within the service area, coordinating meetings, managing conflicts, and supporting the implementation of strategic initiatives.

ADDITIONAL FUNCTIONS

• Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
• May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.

MINIMUM QUALIFICATIONS

Education and Experience: Bachelor’s Degree in Business Administration, Finance, Accounting, and/or Health-related fields. At least five (5) years of experience in a position performing analytical tasks, managing healthcare-related tariffs, network management, contract negotiation, and healthcare economics. Experience in analyzing contracting models is required.

"Proven experience may be replaced by previously established requirements."

Certifications / Licenses: A valid driver's license in the Commonwealth of Puerto Rico is required.

Other: Car in good condition and available to travel to different locations in Puerto Rico. Intermediate-Advanced Excel knowledge. SQL, SAS, and Power BI knowledge are highly desired.

Languages

Spanish – Advanced (comprehensive, writing and verbal)
English – Advanced (comprehensive, writing and verbal)

"We are an Equal Employment Opportunity Employer and take Affinitive Action to recruit Protected Veterans and Individuals with Disabilities."