Verda Health Plan of Texas (Verda Healthcare, Inc) has a contract with CMS and a state license with the Texas Department of Insurance for a Medicare Advantage Prescription Drug (MAPD) plan. We are committed to ensuring healthcare is easily and equitably accessed by all. Our mission is to ensure underserved communities have access to health and wellness services, and receive the support needed to live a healthy life that is free of worry and full of joy. We are looking for a
Provider Network Manager
to join our growing company with many internal opportunities.
Are you ready to join a company that is changing the face of health care across the nation? Verda Healthcare, Inc is looking for people who value excellence, integrity, caring, and innovation. As an employee, you’ll join a team dedicated to improving the lives of our Medicare members. Our vision incorporates value-based health care that works. We value diversity.
Position Overview The Provider Network Manager (PNM) serves as the primary source of Provider Relations for assigned territories, which may change from time-to-time, and works with Network Development to introduce Verda Healthcare and secure participation agreements. The PNM increases Verda Healthcare’s brand with providers by identifying, researching, vetting, and developing assessments of provider and business landscapes, ensuring alignment with Verda Healthcare. The PNM supports provider network growth strategies and development in all markets. This position reports to the Senior Director of Provider Network.
Job Description
Responsible for provider relations and provider liaison functions
Conduct initial outreach and telephonic communication to identify provider interest and qualify them for contracting
Identify and research resources for developing IPA/Medical group provider leads for new business areas and gaps in provider specialties
Cultivate a deep understanding of market conditions to determine if practices belong to larger systems that contract as single entities
Participate in quarterly JOCs and in-servicing providers as necessary to fully serve our members as contractually required; additionally assist in provider-related issues such as eligibility and member benefits
Work with Executive leadership team regarding strategy, program development, provider recruitment, contracting and onboarding initiatives
Develop an adequate provider network in assigned geographical areas
Maintain relationships and all provider-relations activities in assigned geographical area until transition to Local Network is completed
Report directly to the Director for status, risks and potential opportunities in area on a regular basis
Monitor performance, develop and implement business solutions to address process and quality gaps, and communicate network strategy and planning
Vendor oversight
Ability to travel
Special Projects as assigned
Requirements
Bachelor's degree preferred in Business/Economics, Healthcare Administration, or related field
Master’s degree or equivalent preferred
5+ years minimum experience in managed care contracting (provider relations, provider network development)
Experience with bundled payment contracting or risk and capitation required
Proven track record in negotiations and leading meetings, creating agendas, and achieving goals
Professional Competencies
Microsoft Office and intermediate computer skills
Knowledge of Network Management Processes & Services
Ability to manage and prioritize multiple tasks, promote teamwork and fact-based decision making
Communication skills
Ability to work independently and within a team environment
Attention to detail
Familiarity with the healthcare field
Critical listening and thinking skills
Training/teaching skills
Strategic management and time management skills
Proper phone etiquette
Decision making/problem solving skillsResiliency in a changing environment
Demonstrated progression of leadership and responsibility
Ability to work in a fast-paced, start-up culture
Proven ability to build, develop, and lead strong teams of operators
Benefits
401(k)
Paid time off (vacation, holiday, sick leave)
Health insurance
Dental insurance
Vision insurance
Life insurance
Schedule
Full-time onsite (100% in-office)
Hours of operations: 9am – 6pm
Standard business hours Monday to Friday/weekends as needed
Occasional travel may be required for meetings and training sessions
Ability To Commute/Relocate
Reliably commute or planning to relocate before starting work (Required)
Physical Demands Regularly sit/walk at a workstation in an office or cubicle setting. Must occasionally lift and/or move up to 25-50 pounds. Other duties may be assigned in support of departmental goals.
#J-18808-Ljbffr
Provider Network Manager
to join our growing company with many internal opportunities.
Are you ready to join a company that is changing the face of health care across the nation? Verda Healthcare, Inc is looking for people who value excellence, integrity, caring, and innovation. As an employee, you’ll join a team dedicated to improving the lives of our Medicare members. Our vision incorporates value-based health care that works. We value diversity.
Position Overview The Provider Network Manager (PNM) serves as the primary source of Provider Relations for assigned territories, which may change from time-to-time, and works with Network Development to introduce Verda Healthcare and secure participation agreements. The PNM increases Verda Healthcare’s brand with providers by identifying, researching, vetting, and developing assessments of provider and business landscapes, ensuring alignment with Verda Healthcare. The PNM supports provider network growth strategies and development in all markets. This position reports to the Senior Director of Provider Network.
Job Description
Responsible for provider relations and provider liaison functions
Conduct initial outreach and telephonic communication to identify provider interest and qualify them for contracting
Identify and research resources for developing IPA/Medical group provider leads for new business areas and gaps in provider specialties
Cultivate a deep understanding of market conditions to determine if practices belong to larger systems that contract as single entities
Participate in quarterly JOCs and in-servicing providers as necessary to fully serve our members as contractually required; additionally assist in provider-related issues such as eligibility and member benefits
Work with Executive leadership team regarding strategy, program development, provider recruitment, contracting and onboarding initiatives
Develop an adequate provider network in assigned geographical areas
Maintain relationships and all provider-relations activities in assigned geographical area until transition to Local Network is completed
Report directly to the Director for status, risks and potential opportunities in area on a regular basis
Monitor performance, develop and implement business solutions to address process and quality gaps, and communicate network strategy and planning
Vendor oversight
Ability to travel
Special Projects as assigned
Requirements
Bachelor's degree preferred in Business/Economics, Healthcare Administration, or related field
Master’s degree or equivalent preferred
5+ years minimum experience in managed care contracting (provider relations, provider network development)
Experience with bundled payment contracting or risk and capitation required
Proven track record in negotiations and leading meetings, creating agendas, and achieving goals
Professional Competencies
Microsoft Office and intermediate computer skills
Knowledge of Network Management Processes & Services
Ability to manage and prioritize multiple tasks, promote teamwork and fact-based decision making
Communication skills
Ability to work independently and within a team environment
Attention to detail
Familiarity with the healthcare field
Critical listening and thinking skills
Training/teaching skills
Strategic management and time management skills
Proper phone etiquette
Decision making/problem solving skillsResiliency in a changing environment
Demonstrated progression of leadership and responsibility
Ability to work in a fast-paced, start-up culture
Proven ability to build, develop, and lead strong teams of operators
Benefits
401(k)
Paid time off (vacation, holiday, sick leave)
Health insurance
Dental insurance
Vision insurance
Life insurance
Schedule
Full-time onsite (100% in-office)
Hours of operations: 9am – 6pm
Standard business hours Monday to Friday/weekends as needed
Occasional travel may be required for meetings and training sessions
Ability To Commute/Relocate
Reliably commute or planning to relocate before starting work (Required)
Physical Demands Regularly sit/walk at a workstation in an office or cubicle setting. Must occasionally lift and/or move up to 25-50 pounds. Other duties may be assigned in support of departmental goals.
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