Manager, Provider Network & Basic Health Plan Implementation

Enlightened, Inc.•Washington, DC

About The Position

Enlightened is seeking an experienced Manager, Provider Network & Basic Health Plan Implementation to lead the strategic execution and operational rollout of the Basic Health Plan (BHP) within the provider network. This position ensures seamless provider integration, manages cross-functional coordination, and drives performance outcomes aligned with both regulatory requirements and organizational goals. The Manager may oversee a team of direct reports and will leverage advanced Excel expertise to support data-driven decision-making.

Requirements

Bachelor’s degree in healthcare administration, public health, business, or a related field (Master’s preferred).
5+ years of experience in provider network management, health plan operations, or healthcare project implementation.
Demonstrated leadership experience with a track record of managing teams and achieving results.
Strong knowledge of Medicaid, Basic Health Plans, and provider contracting.
Expert-level proficiency in Microsoft Excel (pivot tables, formulas, and data visualization).
Excellent communication, negotiation, and stakeholder engagement skills.

Nice To Haves

Experience working with state health agencies or managed care organizations.
Familiarity with value-based care models and provider performance analytics.
Proficiency with project management tools and healthcare data systems.

Responsibilities

Lead end-to-end implementation of the Basic Health Plan across the provider network.
Develop and manage project plans, timelines, and deliverables with internal and external stakeholders.
Oversee provider onboarding, contracting, and integration processes specific to the BHP.
Serve as the primary liaison between provider organizations and internal departments to ensure alignment and compliance.
Monitor provider performance metrics to ensure adherence to health plan standards and regulatory requirements.
Collaborate with compliance and quality teams to address performance gaps and implement corrective actions.
Identify opportunities to streamline workflows and enhance provider engagement.
Contribute to strategic planning initiatives for network expansion and program optimization.
Facilitate communication with state agencies, health plan partners, and provider organizations.
Prepare reports, presentations, and updates for executive leadership and regulatory bodies.
Provide mentorship, performance management, and professional development to direct reports.
Foster a collaborative, accountable, and results-driven team culture.
Use advanced Excel skills to analyze provider data, track implementation progress, and generate actionable insights.
Create dashboards, models, and reports to support strategic decisions.