Senior Manager Prof Provider Network Performance - Work From Home

Health Care Service Corporation•Biloxi, MS

1d•$92,700 - $167,500•Hybrid

About The Position

This position manages provider relationships and agreements while leading staff through training, coaching, performance management, and other supervisory responsibilities. The Senior Manager oversees the performance and growth of an assigned provider network, partnering with providers and internal stakeholders to drive quality, affordability, operational excellence, and member satisfaction. The role provides leadership for Provider Performance teams; oversees provider network financial performance and value-based initiatives; supports Stars and Risk Adjustment goals; ensures compliance with CMS and company policies; and collaborates across the organization to strengthen provider relationships, improve health outcomes, and support the growth and profitability of the HealthSpring Medicare Advantage business. This is a field-based position serving Alabama, Southern Mississippi, and the Florida Panhandle. The individual is typically onsite at provider offices three days per week and works from home two days per week. The position may be performed remotely from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii. The schedule is Monday through Friday during typical business hours, with infrequent evening and weekend meetings. Travel, including overnight stays, is required, and the employee must live within 380 miles of the territory served.

Requirements

Bachelor’s degree in Business or a related field plus four years of health care administration or managed care experience; eight years of similar experience may substitute.
Effective verbal and written communication skills to interact with all levels of corporate personnel and assigned providers.
Demonstrated analytical abilities and proficient planning skills.
Effective negotiation skills.
Ability to meet deadlines and work well under pressure.
Team-oriented approach and people skills.
Ability and willingness to travel, including overnight stays.
Must live within 380 miles of the territory served.

Nice To Haves

Previous HEDIS and/or CMS Stars experience.
Solid understanding of health insurance, customer messaging/design, and project management.
Expert-level Excel skills, including pivot tables and VLOOKUP.
Experience in financial/trend analysis.
Proven ability to foster and manage working relationships in a matrix environment to obtain buy-in and drive results.
Master’s degree, MBA, or other advanced degree.

Responsibilities

Manage the development and maintenance of harmonious working relationships with assigned providers.
Negotiate provider agreements.
Assign responsibilities to team members and lead staff through training, coaching, performance management, and other supervisory responsibilities.
Oversee the performance and growth of an assigned provider network.
Partner with providers and internal stakeholders to drive quality, affordability, operational excellence, and member satisfaction.
Lead Provider Performance teams.
Oversee provider network financial performance and value-based initiatives.
Support Stars and Risk Adjustment goals.
Ensure compliance with CMS and company policies.
Collaborate across the organization to strengthen provider relationships, improve health outcomes, and support the growth and profitability of the HealthSpring Medicare Advantage business.