Provider Network Manager

Community Health Plan of Imperial Valley

1d

About The Position

Our team is growing, and we’re looking for a Provider Network Manager to manage the strategic development and operations of CHPIV’s directly contracted Medicare and Medi-Cal provider network. You will be responsible for developing, managing and servicing a network of individually contracted providers and Independent Physician Associations, including network adequacy, provider recruitment and contracting, performance monitoring, and maintaining strong relationships with providers to facilitate high-quality patient care.

Requirements

• Bachelor’s degree in healthcare administration, Business Administration, Public Health, or a related field.
• 5–8 years in provider relations, network management, or managed care

Nice To Haves

• Master's preferred.
• experience with Medicare/MAPD, Medicaid, or integrated delivery systems preferred.

Responsibilities

• Identify gaps in the network, recruit new providers, and expand access to primary care, specialists, ancillary providers and facilities
• Negotiate favorable contract terms, reimbursement rates, service level agreements, and amendments for traditional and non-traditional providers
• Maintain strong relationships with Independent Physician Associations (IPAs), hospitals, and other contracted providers, handling inquiries, escalations, and performance issues. Prepare agenda and lead quarterly joint operating committee meetings with IPAs, hospitals, and primary care providers, as needed.
• Analyze provider performance, network coverage, and regulatory compliance. Educate and manage provider and IPA performance on STARS measures and risk adjustment coding documentation.
• Facilitate provider enrollment, credentialing, orientation, and ongoing education to ensure compliance with plan policies
• Ensure adherence to healthcare regulations and program requirements, including CMS, Medicaid/Medicare standards,
• Work with outsourced vendors and internal subject matter experts to monitor and improve processes related to claims processing, utilization management, finance, and data file exchange.
• Prepare performance reports, analyze network data, and provide strategic recommendations to leadership and other stakeholders.

Benefits

• Competitive salary of $85,000-$115,000/ year
• Comprehensive benefits package that pays 85% of the cost of your family's healthcare
• A 401 (k) with a generous match
• Paid time off and holidays
• Opportunities for growth and professional development
• A chance to make a real difference in the health of your community

What This Job Offers

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