Network Support Manager (US)

CareMore Health Management Services, LLC; Tucson (AZ); On-site; USD 81,000 - 122,000; Full time

Job summary

CareMore Health Management Services, LLC is seeking a Network Support Manager to optimize the provider network for access, quality, and value-based performance. You will oversee operational execution, resolve network issues, and engage providers to align with performance goals.

The role requires collaboration across multiple lines of business, contract administration experience, and knowledge of CMS programs.

Qualifications

• BA/BS degree required with minimum 3 years in health care provider relations, facility contracts, or reimbursement.
• MBA, MHA or related graduate degree strongly preferred.
• Experience with provider contracting language and operational requirements is essential.

Responsibilities

• Oversee day-to-day training, guidance and management of department activities and facilitate resolution of problems.
• Analyze and coordinate strategies, policies and programs to ensure accurate administration of facility provider contracts.
• Create tools to assist contract implementation and administration.
• Interface with providers on contractual obligations, education, and provider operations manual updates.
• Coordinate projects to ensure accurate facility and provider reimbursement policy and procedures.

Skills

Medicare Advantage

Value-based care

CMS programs

Claims analysis

Provider dashboards

EHR navigation

Provider contracting

Education

BA/BS degree

MBA or MHA preferred

Job description

Job Description SummaryThe Network Support Manager ensures that provider network is optimized for access, quality, compliance, and performance. This role is accountable for operational execution, network issue resolution, provider engagement, and alignment to value-based performance goals.How will you make an impact & RequirementsCoordinates workflow and tactical implementation of various activities related to maintaining facility, provider network and contracting initiatives. Participates in projects designed to improve all levels of network performance, which may include multiple lines of business.Technical CompetenciesFamiliarity with Medicare Advantage, Medicaid Managed Care, and value-based care models.Understanding of CMS/state quality programs, risk adjustment, and utilization management.Competency in claims analysis, provider performance dashboards, and EHR/workflow navigation.Experience with provider contracting language and operational requirements.Primary duties may include, but are not limited to:May oversee the 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.Requires a BA/BS degree and a minimum of 3 years' experience in the health care industry with background in provider relations, facility contracts and reimbursement; or any combination of education and experience, which would provide an equivalent background. MBA, MHA or related graduate degree strongly preferred.Compensation Range:$81,492.00to$122,238.00The anticipated base salary range represents the Company's good-faith estimate of the compensation it reasonably expects to pay for this position at the time of posting. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs.