Senior Provider Network Manager

Job description

Our Company Abilis Health Plan: Overview: 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. Responsibilities: - 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...