Sr Mgr, Network Operations - Hybrid

Blue Cross Blue Shield of Arizona; United States; Hybrid; USD 90,000 - 120,000; Full time

Job summary

Blue Cross Blue Shield of Arizona is seeking a Medicaid Segment Provider Network Manager to coordinate communications between Medicaid and the provider network and ensure an adequate network. You will supervise staff, guide contract execution, and drive provider satisfaction in Arizona.

The role requires at least 3 years in network development, a relevant bachelor’s degree, and an AZ driver's license. Hybrid/onsite work within Arizona with full-time commitment and budget responsibilities.

Qualifications

• Minimum of three (3) years’ experience working in network development.
• Bachelor’s Degree in Health Care Administration, Business Administration, Finance, Economics, Accounting, or Management.
• Valid Arizona Driver’s license required as travel is required.

Responsibilities

• Lead the team and projects on a proactive, timely, accurate, strategic, and independent basis while producing successful results.
• Oversee and has direct accountability for relationship management, managing trends and provider issues, staff management, and provider database management for hospital, ancillary, and physician contracting.
• Develop goals, work plans, and schedules for Provider Network Management staff and ensure that they are executed.
• Routine interaction with internal departments to ensure terms in contracts are implemented as intended.
• Represent administration at provider meetings (JOC Meetings) and achieve financial objectives.
• Plan, assign, monitor, and appraise staff results.
• Develop, implement, and enforce policies and procedures.

Skills

Provider network dev

Provider relations

Team leadership

Budget management

Strategic planning

Communication

Problem solving

Presentation skills

Education

Bachelor's degree in healthcare/ business/ finance/ economics/ accounting/ management

Job description

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy.

AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote.

While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:

Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week
Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week
Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month
Onsite: daily onsite requirement based on the essential functions of the job
Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

Please note that onsite requirements may change in the future, based on business need, and job responsibilities.

Most employees should expect onsite requirements and at a minimum of once per week.

This position is hybrid within the state of AZ only. This hybrid work opportunity requires residency, and work to be performed, within the State of Arizona.

PURPOSE OF THE JOB

Directly responsible for ensuring coordination of communications between the Medicaid Segment and the provider network, while maintaining a sufficient provider network through avenues such as provider satisfaction, continuous review of network adequacy, and provider demographic accuracy. Oversees Provider Services staff and ensures there is sufficient staff to enable providers to receive prompt resolution to their problems or inquiries and appropriate education about participation in the Medicaid Segment network.

REQUIRED QUALIFICATIONS

Required Work Experience Minimum of three (3) years’ experience working in network development

Required Education Bachelor’s Degree in Health Care Administration, Business Administration, Finance, Economics, Accounting, or Management.

Required Licenses Valid Arizona Driver’s license required as travel is required.

Required Certifications N/A

PREFERRED QUALIFICATIONS

Preferred Work Experience N/A

Preferred Education Master’s Degree

Preferred Licenses N/A

Preferred Certifications N/A

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

Lead the team and projects on a proactive, timely, accurate, strategic, and independent basis while producing successful results.

Oversee and has direct accountability for relationship management, managing trends and provider issues, staff management, and provider database management for hospital, ancillary, and physician contracting.

Develop goals, work plans, and schedules for Provider Network Management staff and ensure that they are executed.

Routine, proactive, and meaningful interaction with internal departments, including, but not limited to Reimbursement Services, Clinical Operations, Prior Authorization and Member/Provider Services to ensure terms and/or provisions in executed contracts are implemented as intended.

Represent administration at provider meetings (JOC Meetings). Achieve financial objectives. Communicate job expectations to staff.

Plan, assign, monitor, and appraise employee’s job results.

Develop, implement, and enforce policies and procedures.

Maintain, train, orient, mentor, and evaluate staff.

Ensure staff have tools needed to be successful.

Set example of proper behavior and accountability to employees and serve as a role model for what is expected of a Medicaid Segment employee.

Annual department budget is prepared timely and adhered to.

Policies and procedures are updated annually (more often if necessary).

Staff is maintained at an adequate level and receives appropriate training to perform job.

Staff have clearly defined and up-to-date job descriptions with specific goals and objectives.

Employee issues (performance, behavior, compliance with policies, etc.) are addressed timely and appropriately in accordance with company policies.

Valid Arizona Driver’s license required as travel is required.

The position has an onsite expectation of 2 days per week and requires a full-time work schedule.

Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.

REQUIRED COMPETENCIES

Required Job Skills Experience with network operational systems and processes

Experience leading development of proactive and effective provider relations

Experience building and managing onsite and remote teams

Track record of improving processes, teams, and performance

Strategic and critical thinking skills

Problem solving/analysis

Strong Presentation Skills Required

Professional Competencies Experience collaborating with teams, vendors, and resources

Independent decision‑making abilities

Results driven and client focused

Initiative and proven organizational skills

Proactive problem-solver focused on quality improvement

Computer experience necessary

Effective interpersonal and communication skills

Ability to multi-task and prioritize work tasks to adhere to deadlines and identified time frames

Ability to manage large workload

Ability to maintain positive work relationships experience and knowledge of general health plan operations

Required Leadership Experience and Competencies N/A

PREFERRED COMPETENCIES

Preferred Job Skills N/A

Preferred Professional Competencies N/A

Preferred Leadership Experience and Competencies N/A

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Our Commitment

AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank you for your interest in Blue Cross Blue Shield of Arizona.

For more information on our company, see azblue.com.

Imagine doing life-changing work and helping more than one million Arizonans live healthier and longer lives. That’s the kind of satisfaction you’ll find when you work here.

Our exceptional teams in Phoenix, Tucson, Chandler, and Flagstaff have been transforming healthcare for more than 80 years.

Explore what's possible with a career at Blue Cross BlueShield of Arizona