Network Optimization & Provider Relations Manager

CareMore Health; United States; Remote; USD 81,000 - 122,000; Full time

Job summary

CareMore Health is seeking a Network Support Manager in the United States to optimize the provider network for access, quality, compliance, and performance. You will lead operational execution, resolve network issues, engage providers, and align with value-based performance goals.

The role involves coordinating workflow for facility/provider network activities, and supporting contracting initiatives across multiple lines of business and platforms.

Qualifications

• Requires BA/BS and minimum 3 years’ experience in the health care industry with background in provider relations, facility contracts and reimbursement; MBA, MHA or related graduate degree strongly preferred.

Responsibilities

• Oversee day-to-day training, guidance and management of department activities and facilitates resolution of problems and issues.
• Analyzes and coordinates strategies, policies and programs to ensure accurate administration of facility provider contracts across multiple lines of business and multiple platforms.
• Creates tools to assist contract implementation and administration.
• Interfaces with providers on contractual obligations, education, and provider operations manual updates.
• Coordinates and acts as a business partner on projects that ensures accurate facility and provider reimbursement policy and procedures, such as pricing, POC, OHAS HMO AND OHAS II, complaints and appeals etc.

Skills

Medicare Advantage

Medicaid Managed Care

Value-based care

CMS programs

Risk adjustment

Utilization management

Claims analysis

Provider dashboards

EHR navigation

Provider contracting

Education

Bachelor's degree

MBA

MHA

Job description

CareMore Health is seeking a Network Support Manager in the United States to optimize the provider network for access, quality, compliance, and performance. You will lead operational execution, resolve network issues, engage providers, and align with value-based performance goals.

The role involves coordinating workflow for facility/provider network activities, and supporting contracting initiatives across multiple lines of business and platforms.