Provider Network Relations Manager — Onsite

BCforward; Tucson (AZ); On-site; USD 80,000 - 100,000; Full time

Benefits offered by this job

major medical

HSA

dental

vision

employer-provided group life

voluntary life insurance

short-term disability

long-term disability

401k

Job summary

BCforward seeks a Network Support Manager to join our team in a on-site role focusing on provider network operations, facility and provider contracting, and value-based care initiatives.

The successful candidate will optimize network access, quality, compliance, and performance while driving operational execution and provider engagement across multiple lines of business and platforms.

Qualifications

• BA/BS degree and at least 3 years in healthcare with provider relations.
• Experience with provider networks, facility contracts, and reimbursement.
• Familiar with Medicare Advantage, Medicaid Managed Care, and value-based care models.
• Understanding CMS/state quality programs, risk adjustment, and utilization management.
• Excellent communication and stakeholder management.

Responsibilities

• Coordinate workflow and tactical implementation of activities to maintain facility and provider networks and contracting initiatives.
• Oversee day-to-day training, guidance, and management of department activities and resolve issues impacting facilities and providers.
• Analyze and coordinate strategies, policies, and programs to ensure accurate administration of facility and provider contracts across multiple lines of business and platforms.
• Create tools to assist with contract implementation and administration.
• Interface with providers on contractual obligations, education, and updates to provider operations manuals.
• Act as a business partner on projects ensuring accurate facility and provider reimbursement policies and procedures, including pricing, POC, OHAS HMO, OHAS II, complaints, and appeals.
• Participate in projects to improve network performance across multiple lines of business.

Skills

Medicare Advantage knowledge

CMS quality programs

Provider performance dashboards

Provider contracting

Stakeholder management

BA/BS + 3 years

Education

BA/BS degree

Job description

BCforward seeks a Network Support Manager to join our team in a on-site role focusing on provider network operations, facility and provider contracting, and value-based care initiatives.

The successful candidate will optimize network access, quality, compliance, and performance while driving operational execution and provider engagement across multiple lines of business and platforms.