Senior Provider Network Manager

Abilis Health Plan

We are seeking a skilled and detail-oriented Senior Provider Network Manager to join our health plan team. This position is responsible for establishing CMS-compliant, cost-effective, and competitive healthcare provider networks in assigned markets by negotiating agreements with physicians, hospitals, ancillary providers, and other healthcare organizations. The role also includes maintaining positive business relationships with contracted providers, conducting provider education sessions as needed, monitoring and reporting material changes in assigned markets, and serving as a subject matter expert (SME) to other functional areas within the organization.

Lead and oversee contract negotiations with healthcare providers and essential vendors in assigned markets.
• Ensure all contracted providers and essential vendors meet credentialing requirements.
• Analyze the health plan's provider network to ensure ongoing network adequacy.
• Support the implementation of the health plan in new markets, as needed.
• Foster a positive work environment that promotes participation in process improvement and commitment to departmental and organizational success.
• Complete corporate assignments, including but not limited to compliance trainings, as assigned.

• Bachelor's Degree or equivalent work experience.
• Ten (10)+ years of experience in managed care contracting or provider network development.
• Prior experience with Medicare Advantage plans: Institutional Special Needs Plan (I-SNP) experience preferred.
• Reliable transportation.
• Current automobile insurance meeting company policy requirements.
• Familiarity with health plan operations, including benefits, claims, eligibility, and provider network management.
• Strong negotiation, organization, presentation, and time management abilities.
• Effective communication skills with the ability to engage all levels of medical staff to explain health plan programs, benefits, and goals.
• Fluency in Medicare payment methodologies.
• Knowledge of all levels of medical services with the ability to quickly develop productive working relationships.
• Ability to follow instructions and work independently to achieve goals and complete assignments.
• Proven success working collaboratively in a team environment.
• Proficient in Microsoft Office Suite and other relevant computer applications.
• Self-motivated, dependable, and both team and goal-oriented.
• Skilled at managing multiple priorities effectively.
• Travel 25-75%