Provider Network Manager

Overview

• Manage provider network relationships to ensure sustainable and cost-efficient healthcare delivery systems.
• Analyze financial impacts of provider contracts and recommend innovative payment methodologies.
• Develop and implement reimbursement strategies to control healthcare costs effectively.
• Prepare and present financial performance reports to organizational leadership.
• Coordinate and negotiate contracts with provider networks to optimize service delivery.
• Maintain documentation related to processes, training materials, and program requirements.
• Identify and resolve provider payment or utilization variations, ensuring compliance and efficiency.
• Collaborate with healthcare organizations and internal teams to enhance network performance.

Key Responsibilities & Duties

• Audit and monitor financial performance of providers to ensure network sustainability.
• Analyze, review, and project financial impacts of contract arrangements.
• Develop cost-efficient networks and identify opportunities for efficiency improvements.
• Ensure accurate implementation and administration of executed networks and programs.
• Prepare and present financial performance reports to leadership and stakeholders.
• Formulate, analyze, and negotiate contracts with provider networks.
• Maintain professional relationships with providers and address their ongoing needs.
• Identify and resolve provider payment or utilization variations effectively.

Job Requirements

• Bachelor’s degree or equivalent work experience in healthcare management or related field.
• Minimum of 4 years’ experience in provider contract/network management or relevant areas.
• Proficiency in provider reimbursement methodologies and negotiation strategies.
• Strong analytical skills to evaluate financial impacts and recommend solutions.
• Ability to prepare and present detailed financial performance reports.
• Experience in maintaining documentation and training materials for network programs.
• Effective communication skills to collaborate with providers and internal teams.
• Knowledge of healthcare cost control and risk mitigation strategies.