Provider Network Manager

🔥 15 hours ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.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.

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American Health Partners

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1976

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

American Health Partners is a healthcare organization focused on improving access to and coordination of high-quality care through a continuum of services tailored to institutional and special-needs populations. The company operates institutional special needs health plans and provides specialized care coordination, geriatric inpatient and acute psychiatric care, and pharmacy services for long-term-care facilities, supported by an owned/affiliated network of locations and thousands of contracted providers. American Health Partners emphasizes convenient, preventive care to reduce costly hospital stays and improve patient outcomes and quality of life.

📋 Description

• Execute agreements with healthcare providers and essential vendors in assigned markets to establish competitive and cost-effective healthcare provider networks that meet CMS network adequacy standards • Ensure providers and essential vendors meet credentialing requirements • Analyze the Health Plan(s) provider network to maintain network adequacy on an ongoing basis • Support implementation of Health Plan(s) in new markets as needed • Establish a positive work environment that encourages process improvement and commitment to department/company success • Complete corporate assignments, including compliance training, as assigned • Maintain positive business relationships with contracted providers • Report on material changes in assigned markets • Serve as a subject matter expert for other functional areas within the organization

🎯 Requirements

• Must have knowledge and familiarity with all levels of medical services and ability to rapidly develop working relationships • Must be able to accept instructions and work independently in the completions of goals and assignments • Must have strong negotiation, organization, presentation, and time management skills • Must be able to effectively communicate with medical staff to explain the Health Plan(s) program, benefits, and goals • Must be able to work effectively in a team environment • Excellent computer skills, including Microsoft Office Suite • Must be self-motivated, dependable, team and goal oriented • Successful completion of required training • Handle multiple priorities effectively • Independent discretion/decision making • Reliable transportation • Current automobile insurance according to company policy • Bachelor’s degree or equivalent work experience • Five (5) plus years of experience in managed care/network development/network services • Experience in the health care field required • Prior experience with Medicare Advantage plans is helpful • Prior experience in network development/network services is required • Prior experience with acute and post-acute facilities is beneficial • Must be available to work 8 a.m. until 5 p.m. local time • Position requires intermittent travel to network provider locations

🏖️ Benefits

• Affordable Medical/Dental/Vision insurance options • Generous paid time-off program and paid holidays for full time staff • TeleDoc 24/7/365 access to doctors • Optional short- and long-term disability plans • Employee Assistance Plan (EAP) • 401K retirement accounts with company match • Employee Referral Bonus Program • Teleworking is an option if criteria is met