Company
Healthcare
Sr.ManagedCareNetworkManager
Neural analysis suggests this role is
optimal for Manager candidates.
“Sr. Managed Care Network Manager. Skills: Managed care plans, Network strategies, Payer contracts. Coordinate managed care plans. Implement managed care plans”
What You'll Achieve.
Achieve favorable reimbursement; Achieve operational outcomes; Enhance managed care operations; Enhance network effectiveness; Support organizational success
Industry & Context.
Problem-solving skills; Issue resolution
What They're Looking For.
Must Have
Bachelor's degree, 7+ years of experience, Provider network management experience, Contract negotiation experience, Contract administration experience, Solid understanding of medical terminology, Solid understanding of CPT coding, Solid understanding of reimbursement methodologies, Proven ability to negotiate, Proven ability to manage complex payer contracts, Proven ability to manage complex payer contract amendments, Experience working with provider groups, Experience working with health plans, Experience working with healthcare delivery systems, Analytical skills, Organizational skills, Problem-solving skills, Ability to manage multiple priorities, Excellent verbal communication skills, Excellent written communication skills, Proficiency in Microsoft Office Suite, Proficiency in Excel, Proficiency in Access, Overall computer literacy, Ability to work independently, Ability to manage deadlines, Ability to manage variable schedules, Interpersonal skills, Ability to build trust, Ability to collaborate across diverse healthcare stakeholders
Nice to Have
Master's degree, Experience in training, Experience in education, Experience in change management within provider environments, Experience in change management within payer environments
What You'll Do.
Coordinate managed care plans
Implement managed care plans
Lead provider group transitions
Ensure smooth onboarding
Ensure alignment with managed care requirements
Develop relationships with managed care plans
Maintain relationships with managed care plans
Negotiate contract terms
Negotiate agreements with payers
Monitor managed care plan performance
Ensure alignment with organizational objectives
Support resolution of escalated issues
Support resolution of claims payment challenges
Support resolution of operational concerns
Coordinate provider credentialing processes
Facilitate training for provider leadership
Facilitate education for provider leadership
Address clinical issues
Address operational issues
Address claims-related issues
Ensure timely resolution
Contribute to continuous improvement initiatives
Enhance managed care operations
Enhance network effectiveness
Review managed care proposals
Evaluate managed care proposals
Ensure alignment with organizational goals
Ensure alignment with financial targets
Perform additional duties
How You'll Work.
Team & Collaboration
Internal teams; Provider groups; External health plan partners; Acquired organizations; Affiliated organizations; Diverse healthcare stakeholders
Communication Scope
Verbal communication; Written communication
Full Job Description
## Accountabilities Coordinate and implement managed care plans by working closely with internal teams, provider groups, and external health plan partners to ensure effective execution of network strategies. Lead provider group transitions, including acquired and affiliated organizations, ensuring smooth onboarding and alignment with managed care requirements. Develop and maintain strong relationships with managed care plans through consistent communication, negotiation, and partnership management. Negotiate contract terms, amendments, and agreements with payers to achieve favorable reimbursement and operational outcomes. Monitor managed care plan performance to ensure compliance, efficiency, and alignment with organizational objectives. Support resolution of escalated issues, claims payment challenges, and operational concerns related to managed care contracts. Coordinate provider credentialing processes for affiliated and acquired groups within managed care networks. Facilitate training and education for provider leadership on managed care policies, procedures, and requirements. Collaborate with stakeholders to address clinical, operational, and claims-related issues and ensure timely resolution. Contribute to continuous improvement initiatives aimed at enhancing managed care operations and network effectiveness. Review and evaluate managed care proposals to ensure alignment with organizational goals and financial targets. Perform additional duties as needed to support managed care network performance and organizational success. Requirements Bachelor’s degree in Healthcare, Business, or a related field (Master’s preferred). 7+ years of experience in healthcare, insurance, provider relations, or managed care environments. Strong experience in provider network management, contract negotiation, and contract administration. Solid understanding of medical terminology, CPT coding, and reimbursement methodologies. Proven ability to negotiate and manage complex payer cont
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