Manager, Network Relations
Core
Primary resource for high-profile providers to establish and maintain relationships, resolving complex issues regarding Medicaid policies, plan design, contracts, and claims.
Role type
Manager, Network Relations
Builds
Positive provider relationships and operational support for Medicaid managed care networks
Domain
Healthcare / Medicaid Managed Care
Deliverable
client delivery
Required skills
Medicaid policy interpretation, contract management, provider education, cross-functional collaboration, database management, credentialing support, agenda facilitation, cost initiative execution
Preferred skills
Medicaid regulatory standards knowledge, medical terminology (CPT, ICD-10), network performance standards
Responsibilities
Optimize interactions with assigned providers, monitor service capabilities, resolve escalated claims and contract issues, support operational activities including database management, perform credentialing support, educate providers on compliance, meet with key providers to ensure service levels, manage external provider meetings, collaborate on large provider system implementations
Seniority
Manager, hands-on IC