Provider Network Manager - Carrollton

Verda Healthcare

Carrollton (TX)

On-site

USD 80,000 - 100,000

Full time

14 days+

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Benefits offered by this job

401(k)

Paid time off

Health insurance

Dental Insurance

Vision insurance

Life insurance

Job summary

Verda Healthcare in Carrollton, TX, is seeking a Provider Network Manager to enhance its network relationships and streamline operations. The role entails managing provider relations, conducting outreach, and developing network growth strategies. Candidates should possess at least a Bachelor's degree and 5+ years of experience in managed care contracting. The position is full-time, with a strong emphasis on communication, negotiation, and strategic teamwork. Benefits include health insurance, 401(k), and paid time off.

Qualifications

5+ years of experience in managed care contracting.
Experience with bundled payment contracting or risk and capitation required.
Proven track record in negotiations and leading meetings.

Responsibilities

Responsible for provider relations and liaison functions.
Conduct outreach and telephonic communication to identify provider interest.
Develop an adequate provider network in assigned geographical areas.

Skills

Microsoft Office

Negotiation

Leadership

Time management

Communication

Critical thinking

Education

Bachelor's degree in Business/Economics or related field

Master’s degree or equivalent

Job description

Verda Health Plan of Texas has a contract with the Center of Medicaid and Medicare Services (CMS) and a state license with the Texas Department of Insurance for a Medicare Advantage Prescription Drug (MAPD) plan. We are committed to the idea that healthcare should be easily and equitably accessed by all. Our mission is to ensure that underserved communities have access to health and wellness services, and receive the support needed to live a healthy life that is free of worry and full of joy.

We are looking for a Provider Network Manager to join our growing company with many internal opportunities. Are you ready to join a company that is changing the face of health care across the nation? Verda Healthcare, Inc is looking for people who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to improving the lives of our Medicare members. Our vision incorporates value-based health care that works. We value diversity. Align your career goals with Verda Healthcare, Inc and we will support you all the way.

Position Overview

The Provider Network Manager (PNM) serves as the primary source of Provider Relations for assigned territories, which may change from time-to-time, with targeted providers in an assigned territory. The PNM coordinates with the Network Development team to initiate conversations to introduce Verda Healthcare and to develop communications, with the objective to secure participation agreements in accordance with company policies and procedures. The PNM plays a critical role in increasing Verda Healthcare’s brand with providers by identifying, researching, vetting, and developing an assessment of the provider and the overall business landscape, appropriately identifying providers that align with Verda Healthcare. This individual also supports provider network growth strategies and provider network development in all markets.

This position reports to the Senior VP of Operations as part of Verda Healthcare, Inc.

Responsibilities

Responsible for provider relations and provider liaison functions
Conduct initial outreach and telephonic communication to identify provider interest and qualify them for contracting
Identify and research resources for developing IPA/Medical group provider leads for new business areas and gaps in provider specialties
Cultivate a deep understanding of market conditions to determine if practices belong to larger systems that contract as single entities
Participate in quarterly JOCs and in-servicing providers as necessary to fully serve our members as contractually required; also assist in provider related issues such as eligibility, member benefits, etc.
Work with Executive leadership team regarding strategy, program development, provider recruitment, contracting and onboarding initiatives
Develop an adequate provider network in assigned geographical areas
Maintain relationships and all provider relations in assigned geographical area until transition to Local Network is completed
Report directly to the Director for status, risks, and potential opportunities in area on a regular basis
Monitor performance, develop, and implement business solutions to address process and quality gaps, and communicate network strategy and planning
Vendor oversight
Ability to travel
Special Projects as assigned

Requirements

Minimum Qualifications

Bachelor's degree preferred in Business/Economics, Healthcare Administration, or related field
Master’s degree or equivalent preferred
5+ years minimum experience in managed care contracting (provider relations, provider network development)
Experience with bundled payment contracting or risk and capitation required
Proven track record in negotiations and leading meetings, creating agendas, and achieving goals

Professional Competencies

Microsoft Office and Intermediate computer skills
Knowledge of Network Management Processes & Services
Ability to manage and prioritize multiple tasks, promote teamwork and fact-based decision making
Communication skills
Ability to work independently and within a team environment
Attention to detail
Familiarity of the healthcare field
Critical listening and thinking skills
Training/teaching skills
Strategic management and Time management skills
Proper phone etiquette
Decision making/problem solving skills
Resiliency in a changing environment
Demonstrated progression of leadership and responsibility
Ability to work in a fast-paced, start-up culture
Proven ability to build, develop, and lead strong teams of operators

Job Type