Manager, Provider Network Operations

🔥 13 hours ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $103.8k - $132.3k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🌐 Network Operations

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Alliance Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2012

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

Alliance Health is a regional health plan serving residents of several North Carolina counties by administering Medicaid and state-funded behavioral health and specialty services. It operates Tailored Plan coverage and Medicaid Direct options that integrate physical health, pharmacy, behavioral health, intellectual/developmental disability (I/DD), and traumatic brain injury (TBI) services, provides 24/7 behavioral health crisis support, member and provider portals, community trainings and outreach, and coordinates care through provider networks and governance committees.

📋 Description

• Support the Director of Provider Network Operations in strategic and operational oversight of Provider Relations and PN Operations and Service Development teams • Oversee daily operations, monitor team performance, service metrics, and operational outcomes • Directly supervise Provider Relations Supervisor and Supervisor PN Operations and Service Development • Provide coaching, mentorship, performance management, workforce planning, staff development, succession planning, and employee engagement support • Identify opportunities to streamline workflows and improve operational efficiency • Develop, implement, and monitor standardized processes, tools, and procedures • Evaluate operational challenges and implement sustainable solutions • Develop and analyze operational reports, dashboards, and performance metrics • Monitor departmental goals and key performance indicators • Recommend operational improvements and strategic opportunities to the Director of Network Operations • Ensure compliance with organizational policies, documentation standards, and regulatory requirements • Partner with Contracting, Claims, Quality, Care Management, Finance, and other departments • Facilitate communication and coordination between teams to address system and process issues • Participate in organizational initiatives impacting provider network performance and operations • Lead special projects related to provider relations, operations, and development • Assist the Director of Provider Network Operations with project action plans and special projects

🎯 Requirements

• Selected candidate must reside in North Carolina • Bachelor’s degree from an accredited college or university in Human Services, Education, Sociology, Business, Public Administration, or related field and seven (7) years of experience in community, business, or governmental programs in health related fields, including two years of supervisory, consultative or administrative experience; or Master’s degree in a related field and three (3) years of experience in such programs, including two years of supervisory, consultative or administrative experience • Prior experience with Standard Plan or Tailored Plan preferred • General knowledge of Provider Contract requirements • General healthcare knowledge • Knowledge of database systems for reporting and transmission of data • Thorough knowledge of Microsoft Office Suite, particularly MS Word and MS Excel • Strong interpersonal skills with ability to communicate with appropriate staff • Demonstrated supervision skills • Problem solving skills • Ability to identify and correct credentialing reporting issues via Microsoft Excel and credentialing database • Ability to manage several projects • Ability to prepare technical reports

🏖️ Benefits

• Medical, Dental, Vision, Life, Long Term Disability • Generous retirement savings plan • Flexible work schedules including hybrid/remote options • Paid time off including vacation, sick leave, holiday, management leave • Dress flexibility • Fringe benefit package