Nrharural
Network Manager
Nrharural, Houston, Texas, United States, 77246
JOB SUMMARYThe Network Manager at Community Health Choice is responsible for network development and management. This role involves expanding provider networks for existing and new lines of business, negotiating provider agreements, ensuring regulatory compliance, and maintaining effective relationships with providers. The Provider Network Manager collaborates with various internal departments to achieve departmental goals and contribute to the overall success of the organization.
JOB SPECIFICATIONS AND CORE COMPETENCIESNegotiate Provider Contracts:Negotiate contract language and rates with hospital, physician, ancillary, and LTSS providers in accordance with established parameters and guidelines. Collaborate with Compliance, Legal, and Credentialing teams to finalize provider contracts, including amendments and new agreements. Ensure compliance with regulatory and product requirements related to provider contracting, including network adequacy standards.Expand Provider Networks:Actively seek opportunities to expand provider networks for existing and new lines of business. Conduct external meetings with prospective and existing providers to negotiate or renegotiate agreements. Collaborate with other relevant teams to facilitate network expansion efforts.Ensure Compliance and Network Adequacy:Assure compliance with regulatory requirements and product specifications related to provider contracting functions. Monitor and ensure network adequacy, making necessary adjustments to meet regulatory standards. Coordinate with Network Management, Claims, and Provider Data Integrity teams to ensure accurate contract reimbursement and adherence to requirements.Contribute to Departmental Goals:Actively contribute to the achievement of departmental goals as outlined in the annual business plan. Participate in departmental process improvement initiatives to enhance operational efficiency and effectiveness.Provider Relationship Management:Serve as a liaison between Community Health Choice and its providers, facilitating communication and addressing any issues that arise. Resolve problems and ensure smooth operations by maintaining positive relationships with providers.Other Duties:Perform other duties as assigned to support the overall functioning of the department.QUALIFICATIONS:Education/Specialized Training/Licensure:Bachelor's degree or7 years' experience in lieu of degree (Must be the equivalent combination of required education and minimum experience.)Work Experience:Minimum of three (3) years of experience in healthcare, providers/managed care, contracting, and relations with degree.Minimum of seven (7) years of experience in healthcare, providers/managed care, contracting, and relations without degree.Software Proficiencies:
Microsoft Office (Word, Excel, Outlook)Other:Must have a vehicle and a valid State of Texas Driver's License.Must have managed care contract negotiation experience, preferably in the Houston market.Experience with Star Plus, LTSS, HCBPs, and Medicare products is a plus.
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JOB SPECIFICATIONS AND CORE COMPETENCIESNegotiate Provider Contracts:Negotiate contract language and rates with hospital, physician, ancillary, and LTSS providers in accordance with established parameters and guidelines. Collaborate with Compliance, Legal, and Credentialing teams to finalize provider contracts, including amendments and new agreements. Ensure compliance with regulatory and product requirements related to provider contracting, including network adequacy standards.Expand Provider Networks:Actively seek opportunities to expand provider networks for existing and new lines of business. Conduct external meetings with prospective and existing providers to negotiate or renegotiate agreements. Collaborate with other relevant teams to facilitate network expansion efforts.Ensure Compliance and Network Adequacy:Assure compliance with regulatory requirements and product specifications related to provider contracting functions. Monitor and ensure network adequacy, making necessary adjustments to meet regulatory standards. Coordinate with Network Management, Claims, and Provider Data Integrity teams to ensure accurate contract reimbursement and adherence to requirements.Contribute to Departmental Goals:Actively contribute to the achievement of departmental goals as outlined in the annual business plan. Participate in departmental process improvement initiatives to enhance operational efficiency and effectiveness.Provider Relationship Management:Serve as a liaison between Community Health Choice and its providers, facilitating communication and addressing any issues that arise. Resolve problems and ensure smooth operations by maintaining positive relationships with providers.Other Duties:Perform other duties as assigned to support the overall functioning of the department.QUALIFICATIONS:Education/Specialized Training/Licensure:Bachelor's degree or7 years' experience in lieu of degree (Must be the equivalent combination of required education and minimum experience.)Work Experience:Minimum of three (3) years of experience in healthcare, providers/managed care, contracting, and relations with degree.Minimum of seven (7) years of experience in healthcare, providers/managed care, contracting, and relations without degree.Software Proficiencies:
Microsoft Office (Word, Excel, Outlook)Other:Must have a vehicle and a valid State of Texas Driver's License.Must have managed care contract negotiation experience, preferably in the Houston market.Experience with Star Plus, LTSS, HCBPs, and Medicare products is a plus.
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