Network Representative
Core
Managing and maturing a preferred specialty provider network to ensure referral adherence, optimize patient outcomes, and reduce medical costs.
Role type
Senior Network Representative (Healthcare Operations)
Builds
A high-performing preferred specialist network for a primary care provider
Domain
Healthcare / Medicare Managed Care
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
network curation, relationship management, data analytics, cost analysis, stakeholder education, strategic planning, market intelligence, workflow optimization, independent judgment, travel management
Preferred skills
Medicare HMO experience, managed care environment experience
Technologies
Microsoft Office Suite (Excel, Word, PowerPoint, Outlook), claims systems, medical cost data platforms
Responsibilities
Curation and management of the preferred specialty provider network; Building relationships with preferred specialty providers to drive behaviors; Frequent rounding with preferred specialty providers leveraging analytics; Direct accountability for referrals adherence; Communication and education with clinical, operations, and specialty teams; Collaboration with Health Econ teams to analyze medical cost opportunities; Proactively managing specialist network plans of action and rounding schedules; Supporting communication and collaboration with health plans at city/area and regional levels
Seniority
Senior, hands-on IC
