Provider Network Manager

American Health Communities; Franklin (TN); Hybrid; USD 90,000 - 120,000; Full time

Benefits offered by this job

Affordable Medical/Dental/Vision

Paid time off & holidays

TeleDoc access

Disability plans

EAP

401K with company match

Referral bonus

Job summary

American Health Plans, a division of American Health Partners Inc., seeks a Provider Network Manager in Franklin, TN. You will establish CMS-compliant, cost-effective provider networks and negotiate agreements with healthcare providers across assigned markets.

You will maintain relationships with providers, monitor network adequacy, and support expansion into additional states. Strong negotiation and communication skills are essential for success.

Qualifications

• Bachelor’s degree or equivalent work experience.
• 5+ years in managed care/network development or related field.

Responsibilities

• Establish CMS-compliant, cost-effective provider networks in assigned markets.
• Negotiate agreements with providers and vendors.
• Maintain positive relationships with contracted providers.
• Monitor network adequacy and report material changes.
• Support market expansions and new market implementations.
• Complete corporate assignments including compliance training.

Skills

Negotiation

Provider network development

CMS compliance

Credentialing

Communication

Time management

Education

Bachelor’s degree or equivalent

Tools

Credentialing systems

CMS standards

Job description

American Health Plans
Franklin, TN 37067, USA

Description

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. This division currently operates in Tennessee, Georgia, Missouri, Kansas, Oklahoma, Utah, Texas, Mississippi, Iowa, Idaho, Louisiana, and Indiana with planned expansion into other states in 2025. For more information, visit AmHealthPlans.com .

Benefits and Perks include:

• Affordable Medical/Dental/Vision insurance options
• Generous paid time-off program and paid holidays for full time staff
• TeleDoc 24/7/365 access to doctors
• Optional short- and long-term disability plans
• Employee Assistance Plan (EAP)
• 401K retirement accounts with company match
• Employee Referral Bonus Program

JOB SUMMARY:

The Provider Network Manager is primarily responsible for establishing CMS-compliant, cost-effective and competitive healthcare provider networks in assigned markets by negotiating agreements with healthcare providers. Responsibilities also include maintaining positive business relationships with contracted providers and reporting on material changes in assigned markets while serving as a subject matter expert (SME) for other functional areas within the organization.

ESSENTIAL JOB DUTIES:

To perform this job, an individual must accomplish each essential function satisfactorily, with or without reasonable accommodation.

• Execute agreements with healthcare providers & essential vendors in assigned markets to establish competitive and cost-effective healthcare provider networks, which also meet CMS network adequacy standards.
• Ensure providers and essential vendors meet the credentialing requirements
• Analyze the Health Plan(s) provider network to maintain network adequacy on an ongoing basis
• Support implementation of Health Plan(s) in new markets as needed
• Establish a positive work environment that encourages participation in process improvement and commitment to department/company success
• Complete corporate assignments, including but not limited to compliance training, as assigned

JOB REQUIREMENTS:

• Must have knowledge and familiarity with all levels of medical services and ability to rapidly develop working relationships
• Must be able to accept instructions and work independently in the completions of goals and assignments
• Must have strong negotiation, organization, presentation, and time management skills
• Must be able to effectively communicate with medical staff to explain the Health Plan(s) program, benefits, and goals
• Must be able to work effectively in a team environment
• Must be self-motivated, dependable, team and goal oriented
• Successful completion of required training
• Current automobile insurance according to company policy

REQUIRED QUALIFICATIONS:

• o Bachelor’s degree or equivalent work experience
• o Five (5) plus years of experience in managed care/network development/ network services
• o Experience in the health care field required
• o Prior experience with Medicare Advantage plans is helpful
• o Prior experience in network development/network services is required
• o Prior experience with acute and post-acute facilities is beneficial

WORKING CONDITIONS:

• Must be available to work 8 a.m. until 5 p.m. local time. Occasionally, extended hours may be required for special projects.
• Position requires intermittent travel to network provider locations
• Teleworking is an option if criteria is met

EQUAL OPPORTUNITY EMPLOYER

This Organization is an equal opportunity employer. We do not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. This Organization will make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made. A key part of this policy is to provide equal employment opportunity regarding all terms and conditions of employment and in all aspects of a person's relationship with the Organization including recruitment, hiring, promotions, upgrading positions, conditions of employment, compensation, training, benefits, transfers, discipline, and termination of employment.

This employer participates in E-Verify.

Preferred

Bachelors or better.