Provider Network Operations Leader

0100 PHP Administrative; United States; Presencial; USD 76.000 - 129.000; Jornada completa

Descripción de la vacante

Presbyterian Healthcare Services seeks a Manager- Provider Network Operations to lead the provider network team, ensure contract compliance, and drive initiatives across PHP networks. You will build relationships with providers, educate on policies, and mentor staff while coordinating complex disputes and ensuring access for members.

The role requires leadership, travel to meet providers regionally, and a strong background in managed care operations within a large health system.

Formación

• Bachelor's degree in business administration or related health care field; 6 years experience may substitute for degree.
• Three years in provider relations, provider contracting, claims processing, correct coding, and customer service in managed care.
• Four years of application-specific experience; two years of management preferred.
• Coaching, counseling, and conflict management skills are required.
• Ability to multi-task and collaborate across teams; strong communication required.
• Willingness to travel regionally to recruit, re-contract, and educate providers.

Responsabilidades

• Oversee all aspects of Provider Network Operations to build provider relationships.
• Ensure access to quality care and meet enterprise affordability and sustainability goals.
• Oversee contract compliance with PHP policies and regulatory guidelines.
• Lead and mentor staff; assign work and monitor productivity and KPIs.
• Develop and maintain the provider network; recruit and onboard providers.
• Resolve complex provider contracts and reimbursement issues; escalate as needed.
• Coordinate resolution of issues with senior leadership and stakeholders.
• Ensure regulatory compliance of network activities and reporting.

Conocimientos

Leadership

Coaching

Conflict management

Communication

Multi-tasking

Educación

Bachelor's degree in business administration or related health care field

6 years experience substitute for degree

Three years provider relations/contracting experience

Two years management experience preferred

Descripción del empleo

Presbyterian Healthcare Services seeks a Manager- Provider Network Operations to lead the provider network team, ensure contract compliance, and drive initiatives across PHP networks. You will build relationships with providers, educate on policies, and mentor staff while coordinating complex disputes and ensuring access for members.

The role requires leadership, travel to meet providers regionally, and a strong background in managed care operations within a large health system.