Provider Network & Contract Manager

Senior Care Partners C.E.•Kalamazoo, MI

About The Position

The Program of All-Inclusive Care for the Elderly (PACE) offers a variety of services, with many of them provided onsite at a PACE Center. PACE is an alternative to nursing home care and – through an interdisciplinary care team (IDT) of physicians, nurse practitioners, nurses, social workers, therapists, van drivers, and aides – coordinates and provides preventive, primary, acute, and long-term care services, so older individuals can continue living in the community. The Provider Network and Contracts Manager is responsible for managing provider network operations, including provider contracting, credentialing, compliance, and relationship management. This role ensures a high-quality, compliant provider network that supports participant care and aligns with Federal, State, and organizational requirements. The position provides functional leadership for Provider Network and Contract operations and serves as the primary coordinator for provider contracting, compliance, and credentialing activities while working closely with the Contract Coordinator and cross-functional teams.

Requirements

Bachelor’s degree in business administration, Healthcare Administration, or other applicable experience degree required
3 to 5 years of contracting / insurance / healthcare experience
Strong working knowledge of Medicare and Medicaid billing requirements
Must be fully vaccinated or willing to become vaccinated against: Influenza, MMR, Varicella, Tdap/Td, COVID-19, and Hepatitis B
Must meet CMS competency standards prior to working independently

Nice To Haves

Knowledge of PACE and Medicare Advantage Plans preferred
Comfortable working in varied home environments and all weather conditions

Responsibilities

Develop, negotiate, and manage provider contracts and network relationships.
Ensure provider network adequacy, credentialing compliance, and adherence to CMS and MDHHS requirements.
Monitor provider performance, conduct audits, and manage corrective action plans.
Educate and onboard providers regarding organizational policies, procedures, and the PACE model of care.
Maintain provider network data, contract documentation, and related policies and procedures.
Collaborate with internal departments and external partners to support service delivery, quality outcomes, and value-based care initiatives.
Resolve provider and contract-related issues while maintaining high customer service standards.
Participate in quality improvement, compliance reviews, and regulatory audits.