Manager, Provider Network

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NW, SW, Central Ohio, OH
$75,000 - $105,000
Job Type
Direct Hire
Dec 10, 2018
Job ID

Exclusive Search for Manager, Provider Network to Manage the day-to-day operations of the network accounts department function of this Fortune 100 healthcare enterprise to ensure compliance with health plan, corporate and state policies, procedures, and guidelines to achieve healthy outcomes.
*Candidate can reside in NW, SW or Central Ohio
  • Manage the network accounts team to ensure goals and objectives are met through effective hiring, performance management, training, coaching, and career development
  • Plan, coordinate and participate in scheduled and unscheduled meetings with network account representatives to conduct orientations, training on health plan policies and procedures, and deliver materials or inquire about contracting with our health plan
  • Oversee the planning of health plan-sponsored events acting as host at such events for network account representatives, participating in provider contracting activities to minimize contract implementation issues/errors
  • Receive and respond to all urgent and emergent provider issues, providing guidance in the resolution of complex claims payment and provider systems set-up issues
  • Develop, implement and monitor quality initiatives to achieve healthy outcomes for assigned projectsDevelop and recommend updates to policies and procedures and ensure Provider Manuals are accurate and up-to-date

Bachelor’s degree in related field or equivalent experience.
4+ years of network account management or provider contracting experience in a managed care environment.
Supervisory or lead experience preferred.
Knowledge of managed care and state Medicaid program guidelines.
Proficiency in Microsoft Office products