Network Support Manager (US)

CareMore Health • Tucson, AZ

2d • $81,492 - $122,238 • Remote

About The Position

The Network Support Manager ensures that the provider network is optimized for access, quality, compliance, and performance. This role is accountable for operational execution, network issue resolution, provider engagement, and alignment to value-based performance goals. The Network Support Manager coordinates workflow and tactical implementation of various activities related to maintaining facility, provider network and contracting initiatives. This role participates in projects designed to improve all levels of network performance, which may include multiple lines of business.

Requirements

• BA/BS degree and a minimum of 3 years' experience in the health care industry with background in provider relations, facility contracts and reimbursement; or any combination of education and experience, which would provide an equivalent background.
• Familiarity with Medicare Advantage, Medicaid Managed Care, and value-based care models.
• Understanding of CMS/state quality programs, risk adjustment, and utilization management.
• Competency in claims analysis, provider performance dashboards, and EHR/workflow navigation.
• Experience with provider contracting language and operational requirements.

Nice To Haves

• MBA, MHA or related graduate degree strongly preferred.

Responsibilities

• Oversee the day-to-day training, guidance, and management of department activities and facilitate the resolution of problems and issues.
• Analyze and coordinate strategies, policies, and programs to ensure accurate administration of facility provider contracts across multiple lines of business and multiple platforms.
• Create tools to assist with contract implementation and administration.
• Interface with providers on contractual obligations, education, and provider operations manual updates.
• Coordinate and act as a business partner on projects that ensure accurate facility and provider reimbursement policy and procedures, such as pricing, POC, OHAS HMO AND OHAS II, complaints and appeals.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager