PA Health & Wellness · 3 days ago
Senior Manager, Provider Network Management Operations
United States
Full-time
Remote
Mid, Senior Level
$108K/yr - $199K/yr
5+ years expPA Health & Wellness is a national organization transforming the health of communities, seeking a Senior Manager to oversee network management activities. The role involves managing provider relations, data analytics, and ensuring compliance with regulatory requirements while developing operational models aligned with strategic initiatives.
FitnessHealth CareWellness
No H1B
Responsibilities
Oversee network management activities including network development, provider relations, and provider data analytics within an assigned market
Develop, implement, evaluate, and improve operational models aligned with strategic initiatives and compliant with accreditation, legislative and regulatory requirements
Responsible for overseeing the development of reports to support quality member outcomes, provider recruitment, provider retention, and contracting initiatives
Develop and drive uniformity, efficiencies and consistencies within Provider Network Management promoting
Manage daily activities of staff, including network development, provider relations, and provider data analytics
Oversee quality assurance processes and reporting to ensure compliance with accreditation, federal and state regulatory requirements including access and availability and demographic reporting related to providers
Establish and maintain strong relationships with other divisions to ensure that provider network management activities are linked appropriately to other applicable areas of the organization
Implement and manage development of documented provider network management policies and procedures
Oversee quality audits and compliance reporting across all areas of provider network management
Develop education and communication plans for internal staff and providers
Facilitate and assist with problem resolution for internal provider network management issues but also for broader scope issues that impact provider network management including but not limited to providers, claims, customer contact center, medical management, and appeals and grievances
Perform management duties including budgeting, performance management, staff development, training, staffing, and establishing department goals and objectives
Qualification
Required
Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future
Strong leadership experience
Experience with claims data and roster management
Understanding of health plan operations
Experience in network development, provider relations, and provider network management
Bachelor's Degree in Business, Healthcare, or related field or equivalent experience
5+ years of combined health plan operations, network development, provider relations, or contracting experience
In depth knowledge of compliance and access and availability requirements
Experience with compliance reporting and analyzing data
Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff
Preferred
Oregon residency is preferred due to travel requirements of up to 50% for provider and office visits
Benefits
Competitive pay
Health insurance
401K and stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Flexible approach to work with remote, hybrid, field or office work schedules
Company
PA Health & Wellness
Established to deliver quality healthcare in the state of Pennsylvania through local, regional and community-based resources, PA Health & Wellness is a Managed Care Organization and subsidiary of Centene Corporation (Centene).
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Justin Davis
President and Chief Executive Officer
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