Network Support Manager (US)

CareMore Health • Tucson, AZ

3d

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.

Requirements

• 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.
• A 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.

Nice To Haves

• MBA, MHA or related graduate degree strongly preferred.

Responsibilities

• Coordinates workflow and tactical implementation of various activities related to maintaining facility, provider network and contracting initiatives.
• Participates in projects designed to improve all levels of network performance, which may include multiple lines of business.
• May oversee the day to day training, guidance and management of department activities and facilitates resolution of problems and issues.
• Analyzes and coordinates strategies, policies and programs to ensure accurate administration of facility provider contracts across multiple lines of business and multiple platforms.
• Creates tools to assist contract implementation and administration.
• Interfaces with providers on contractual obligations, education, and provider operations manual updates.
• Coordinates and acts as a business partner on projects that ensures accurate facility and provider reimbursement policy and procedures, such as pricing, POC, OHAS HMO AND OHAS II, complaints and appeals etc.

What This Job Offers

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