Network Manager II

🔥 17 hours ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 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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BlueCross BlueShield of Tennessee

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 1952

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

BlueCross BlueShield of Tennessee is a leading health plan provider in Tennessee, serving 3. 4 million members. The company is committed to creating a workforce where everyone is valued, respected, and part of the team, emphasizing diversity and inclusion. They offer a range of career opportunities, including internships through their BlueBridge program, enabling new professionals to transition from college to work. BlueCross BlueShield of Tennessee also focuses on providing exceptional customer service and community care, striving to make a difference in the healthcare industry. It is an independent licensee of the Blue Cross Blue Shield Association and a qualified health plan issuer in the Health Insurance Marketplace.

📋 Description

• Identify educational topics, methods, and strategies to enhance compliance throughout the provider network • Implement, support, and monitor provider programs and enterprise initiatives • Implement processes and changes to maintain regulatory and contract compliance and improve quality • Handle escalated provider enrollment processing and problem resolution • Lead data reporting and analysis projects monitoring financial and service relations with providers • Consult with providers on delivery, training, and support issues • Identify opportunities for enhancement and recommend solutions • Travel to provider offices or conduct virtual meetings as required • Support and strengthen provider networks across Tennessee • Assist with contract negotiations and resolve complex provider issues • Analyze reimbursement impacts and collaborate with internal teams to improve provider experience and network performance

🎯 Requirements

• Bachelor's degree in business, healthcare, or a relevant field, or equivalent work experience required • 3 years of experience in provider relations and network development, emphasizing healthcare education and reimbursement • Ability to speak publicly and conduct effective presentations • Ability to work independently with minimal supervision or in a team environment • Ability to interpret and translate technical and complex concepts into meaningful information • Proficiency in Microsoft Office, including Outlook, Word, Excel, Access, and PowerPoint • Accuracy and attention to detail • Effective time management skills • Excellent oral and written communication skills • Strong interpersonal and organizational skills • Strong analytical skills • Ability to manage multiple projects and priorities • Positive, self-driven, engaging, proactive, and results-driven attitude • Knowledge of medical terminology • Knowledge of contract language, reimbursement methodologies, managed care business processes, case-mix adjustment, utilization management, and applications for claims payment • Valid driver's license • Maintaining auto insurance compliance and an acceptable motor vehicle record when routinely driving for company business