Provider Network Manager

🕒 Maio 21

🏈 Ohio, Michigan – Remoto

🏈 Ohio – Remote 🚗 Michigan – Remote

💵 $80.000 - $110.000 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

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Devoted Health

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

Fundada em 2017

⚕️ Seguro de Saúde

🧘 Bem-estar

Healthcare Insurance • Wellness

A Devoted Health é uma empresa de saúde que oferece planos Medicare Advantage projetados para fornecer cobertura de saúde abrangente com benefícios adicionais como cuidados dentários, óculos, associações a academias e medicamentos prescritos a preços competitivos. A empresa enfatiza o suporte e serviço ao membro, garantindo que os clientes possam navegar facilmente por seus benefícios e acessar os serviços de saúde necessários. A Devoted Health está comprometida em ajudar os clientes a economizar dinheiro e melhorar sua saúde e bem-estar por meio de um pacote completo de benefícios e suporte.

Descrição

• Development, maintenance and management of an adequate provider network in assigned geographical area • Maintaining relationships and all provider relations activities in assigned geographical area, including negotiating and renegotiating contracts with providers as assigned • Engage internal subject matter experts and providers to identify opportunities to improve provider / member cost and quality performance • Monitoring of various reports to insure all necessary compliance requirements are met and maintained • Reporting to leadership current status, risks, and potential opportunities in area of responsibility on a regular basis • Supporting the overall Network Team as required to achieve success for Devoted Health • Supporting assigned groups to improve performance in CMS STAR measures, including educating providers and their staff on STAR measure requirements, identifying performance gaps through data analysis, coordinating with internal quality teams to implement improvement initiatives, reviewing provider-level performance reports, and working directly with practices to implement workflows and best practices that improve quality outcomes, member satisfaction, preventive care compliance, and clinical documentation accuracy • Utilizing performance dashboards and reporting tools to track STAR measure performance, HEDIS metrics, and other quality indicators, proactively engaging providers whose performance falls below targets and collaborating on action plans to improve results • Partnering with internal quality, clinical, and analytics teams to interpret STAR performance reports and translate insights into actionable strategies for providers, ensuring alignment with organizational goals and CMS quality improvement priorities

🎯 Requisitos

• 5+ years negotiating provider contracts including physician / provider group contracts with multiple payment methodologies including value based/risk • Provider servicing experience • Solid ability to navigate either Google or MS Suite of products • High School Diploma or equivalent minimum • Experience in CMS STAR measures • Experience and relationships in the local market • Unrestricted driver's license to verify your eligibility and capability to fulfill the driving responsibilities associated with the position.

🏖️ Benefícios

• Employer sponsored health, dental and vision plan with low or no premium • Generous paid time off • $100 monthly mobile or internet stipend • Stock options for all employees • Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles • Parental leave program • 401K program • And more....