Network Provider Specialist

Job not on LinkedIn

🕒 October 6

🤠 Texas – Remote

🤠 Texas – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 Ghost score 13%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Nutex Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2011

🏥 Healthcare

🤝 B2B

💰 $10M Post-IPO Equity on 2024-01

Healthcare • B2B

Nutex Health is a health management and operations company that owns, develops, and operates hospitals and provider networks. It operates two divisions: a Hospital Division (micro-hospitals, specialty hospitals, and hospital outpatient departments/HOPDs) that owns and operates over 28 facilities in 12 states, and a Population Health Management Division that runs provider networks such as Independent Physician Associations (IPAs) and Management Services Organizations (MSOs). The company specializes in emergency care and turnkey ER development—handling real estate acquisition, design, staffing, training, and operations—while emphasizing concierge-level patient experience and centralized administrative support for physician groups.

📋 Description

• Manage the physician network by developing and maintaining the assigned IPA/Medical Group • Provide service and education to network physicians/providers and achieve company targets through network improvement plans • Complete new provider orientation for applicable product lines • Conduct provider group meetings to review monthly/quarterly data and outcomes • Record meeting minutes and follow up on identified action items • Conduct provider site visits, resolve issues, educate staff and providers on policies, and collect credentialing information • Educate staff and providers on submitting Risk Adjustment Factor Data and HEDIS information • Maintain relationships with contracted HMOs to implement amendments to DOFR, delegation, policies, and procedures • Return routine provider calls within 24 hours • Oversee inquiries and claims issues and follow up to ensure resolution • Maintain provider office tools, including the provider manual • Support regional Network Improvement Plan targets with utilization reports, ER contingencies, Frequent Flier Reports, and other analytics • Identify network gaps and complete contracts for PCP, Specialist, and Ancillary networks • Identify cost-saving opportunities through collaboration with UM and Claims committees • Explain risk contracts, including shared risk and entire risk • Strategize for membership growth and retention • Train, mentor, and guide new representatives • Work on special projects as assigned or directed • Travel to provider offices and work under general supervision

🎯 Requirements

• Knowledge of MS Office: Word, Excel, PowerPoint, Access Database • Knowledge of MS Provider relations/customer service strategies • Knowledge of MSO-VL and MMSE programs and services: Authorizations, Claims, Credentialing encounters, RAF, Star Ratings, IS/IR, etc. • Knowledge of Network development strategies and Provider Relations experience or similar background • Knowledge of current MSO-VL and MMSE geo-access requirements • Effective and efficient oral and written communication skills • Knowledge of County provider demographics • Skills in negotiating contract language and rate structures • Skills to provide training and technical assistance to contracted providers • Skills to evaluate and assess provider network to determine gaps and services needed • Skills to identify and develop new providers to ensure accessibility • Skills to monitor contract performance through site visits and data analysis • Skills to facilitate contracted provider meetings • Ability to represent the department or division professionally • Ability to establish and maintain effective working relationships with contracted and potential providers • Ability to resolve provider inquiries or requests promptly • Bachelor's Degree in Marketing or Business Administration • Minimum of 2 years experience in Network Management within a managed care environment, health plan, or significant medical group administration

🏖️ Benefits

• 401(k) matching • Dental insurance • Flexible spending account • Health insurance • Life insurance • Paid time off • Vision insurance

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume