Healthcare Provider Network Manager

required * Bachelor's degree or higher * 5+ years of experience in ALL of the following: * related experience in a similar role and education concentration * corporate health plan, venture-backed startups, private equity, or investment banking * 2+ years of experience in ANY of the following: * PowerPoint * Microsoft Office * Excel Our client is seeking a Vendor and Provider Network Manager to play a key role in establishing oversight and management of vendor and provider network partnerships for their integrated care delivery startup.
This individual will be responsible for building, scaling, and continuously improving vendor management and provider network functions, as well as supporting various key departments in KPI development and tracking for vendors.
The ideal candidate will have a strong understanding of health plan, healthcare provider & vendor contracting and regulatory requirements, and be passionate about serving high-risk seniors and frail older adults.
$95,000 - $125,000 a year Our Client offers a robust compensation package for this role that includes cash compensation and other total rewards.
Base pay is based on several factors including but not limited to education, relevant work and industry experience, certifications, and location of the role.
Onsite roles include appropriate geographic adjustments, while remote roles are typically priced off national pay data.
Key Responsibilities ● Manage and provide third party oversight including attestation tracking, vendor governance, auditing oversight, risk management, credentialing and ensuring necessary vendor trainings are up to date ● Identify opportunities to build positive business relationships with potential providers by connecting within the community along with other leaders ● Develop contractual relationships with service providers, drafts contract agreements, and maintains provider network listings ● Partnership with Quality and Compliance team on the establishment of mock audits in preparation for future State and CMS audit readiness ● Support provider network administration, including managing our catalog of contracts, properly loading all contracts into required systems/vendors, and delivering new vendor/provider onboarding ● Support Operations, IT, Finance and other key departments with procurement, vendor management and tracking of various contract types ● Co-lead regular reviews with the Quality & Compliance Director Improvement Manager/Compliance Officer to coordinate quality assessment of providers including onsite visits of providers ● Ensures that applicable websites are monitored monthly and as needed for disciplinary summaries from the Board of Medical Examiners, as well as excluded providers from Medicare and Medicaid (OIG) ● Collaborate with the central and local owners of the vendor relationship and support in ongoing monitoring of vendor performance as needed ● Implement a regular standing meeting with key contract owners at the time of renewal to evaluate performance and contract continuance ● Develop structure for contract repository system to manage that all executed agreements with quality controls in place to ensure all contracts are up to date and tracked ● Collaborate with Quality and Health Plan Compliance teams as needed for any related Fraud, Waste & Abuse (FWA) tracking of vendors/providers ● Manage and provide oversight to selected other external vendors related to any of the functions listed above and more, ensuring quality and adherence to protocols ● Develop policies and procedures that meet applicable PACE program requirements ● Stay current on regulations and policies impacting the PACE program, health plan operations, and our compliance program and share that knowledge across the organization ● Assist the company in ad hoc special projects, including collaborations with external partners, vendor contracting, and other operating model decisions ● Continuously seek improvements to processes and systems across functions as the size and complexity of our business grows ● Communicate confidently and persuasively to all audiences, including external stakeholders Schedule and Shift Details ● Based in Los Angeles in a hybrid onsite/remote capacity, with ability to travel (mainly locally) up to 50% based on business need.
Anticipated onsite role up to 10 days per month.
Travel ● Ability to travel (mainly locally) up to 50% based on business need Job Type: Full-time Pay: $100,000.
00 per year Benefits: * 401(k) * 401(k) matching * Dental insurance * Employee assistance program * Employee discount * Flexible schedule * Flexible spending account * Health insurance * Health savings account * Life insurance * Paid time off * Parental leave * Professional development assistance * Referral program * Relocation assistance * Retirement plan * Tuition reimbursement * Vision insurance Schedule: * 8 hour shift * Monday to Friday Supplemental pay types: * Bonus opportunities Education: * Bachelor's (Required) Experience: * health plan, healthcare provider & vendor contracting: 3 years (Required) Work Location: Hybrid remote in Los Angeles, CA 90057