PROVIDER NETWORK MANAGER jobs in Houston, TX
PROVIDER NETWORK MANAGER manages the operations of a healthcare provider network. Responsible for establishing and maintaining processes and systems to provide routine services to members including contract management and credentialing. Being a PROVIDER NETWORK MANAGER recruits, hires, trains, and measures performance of staff to provide effective and operations within budget. May be involved with the design and operations of database systems used to manage provider data and produce reports and analysis. Additionally, PROVIDER NETWORK MANAGER requires a bachelor's degree. Typically reports to top management. The PROVIDER NETWORK MANAGER typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. To be a PROVIDER NETWORK MANAGER typically requires 3+ years of managerial experience. (Copyright 2024 Salary.com)
Recently Added PROVIDER NETWORK MANAGER jobs
Provider Network Development Specialist
- Apex Health Solutions
-
Houston, TX
FULL_TIME
-
Summary
Position is responsible for network development and adequacy activities including but not limited to: provider data analysis and integrity, maintenance of provider roster, regulatory reporting production, and supporting both product and geographic expansion efforts. This role helps to support several workflow processes within the network development team and will need to be comfortable working with other team members and departments. Typically reports to a Network Operations Leader.
Essential Functions- Responsible for provider research, analysis, & data maintenance to ensure viable and adequate provider network(s)
- Supports the network development team with provider outreach and contracting processes
- Obtains and maintains required documentation from providers that have been targeted for network adequacy
- Consistently monitors network adequacy status and reporting in comparison with applicable requirements and business initiatives
- Provides ongoing support to network management and other internal stakeholders as appropriate
- Composes all correspondence and contract information concisely and accurately, in accordance with regulatory requirements
- Maintains well-organized, accurate, and complete files for all provider data, contracts, outreach, correspondence, outcomes, and supports the accuracy of the network management contract database
- Monitors each request to ensure all internal and external regulatory timelines are met
- Collaborate with internal and external stakeholders to ensure prompt and appropriate action is taken regarding provider network development related activities
- Supports network development activities and initiatives to support improvement in network performance
- Assists in monitoring network composition including review of quality, efficiencies, and member satisfaction
- Reviews network composition and analytics to ensure meeting regulatory requirements, provider accessibility, provider network standards, and network engagement in value-based care goals
- Collaborates with internal teams to develop analytical reports and monitor network, maintain provider resources including the provider manual and provider directory, update of referral management tools, and ensure data integrity of the network.
- Collaborates with teams and providers to promote growth initiatives expanding network and membership growth
Education- High school diploma required;
- Bachelor’s Required or relative experience in healthcare field
- None
- Two years (2) years of experience working in a health care or regulatory environment preferably including experience working with provider clinics, regulatory agencies, data analysis, and project management
- Understanding of CMS and TDI Network Adequacy Standards and Regulations
- Responsible for the outreach of potential network providers to meet the network adequacy regulations and expansion of the current network
- Responsible to collaborate with internal and external stakeholders to meet regulatory reporting deadlines
- Other duties assigned to assist with the success of the network operations team
- Experience with Microsoft Office and Visio
- Skilled in the use of Excel for data analysis
- Preferred systems knowledge – HRP, Symplr (or similar contract database), Quest Analytics, etc.
- Preferred provider relations or network operations experience
- Effective and professional oral and written communication skills
- Strong interpersonal skills to work with all levels across all functional areas to include internal and external business partners
- 1 Month Ago
Network Manager
- BDP International
-
Houston, TX
FULL_TIME
- About BDP International: BDP International, a member of the PSA Group, is a leading provider of global, integrated supply chain, transportation and logistics solutions. The company was founded in 1966...
- 25 Days Ago
Cleaner
- Aware Manager
-
Houston, TX
PART_TIME,FULL_TIME
- CleanerWe are looking for a Cleaner to take care of our facilities and carry out cleaning and maintenance duties. The goal is to keep our building in a clean and orderly condition.ResponsibilitiesClea...
- 26 Days Ago
Network Service Manager
- Covestro LLC
-
Baytown, TX
FULL_TIME
- We are Covestro. We are curious. We are courageous. We are colorful. We refine chemical material solutions with game-changing products. Let us empower you to push boundaries. Join us and our 18,000 co...
- 15 Days Ago
Network Lead / Manager (hands on)
- Columbia Advisory Group
-
South Houston, TX
OTHER
- Overview Lead the IT network team, which includes network servers/workstations, telecommunications, wireless connectivity, data center operations, information systems and information security. Respons...
- 1 Day Ago
Regional Network Ops Manager
- HCLTech
-
Spring, TX
FULL_TIME
- Job DetailsSolid technical skills is managing Network Data environment.The network Ops manager will need to have high level skills in areas such as team management, strong communication and interperso...
- 5 Days Ago
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0 PROVIDER NETWORK MANAGER jobs found in Houston, TX area
About Houston, Texas
Houston is located 165 miles (266 km) east of Austin, 88 miles (142 km) west of the Louisiana border, and 250 miles (400 km) south of Dallas. The city has a total area of 627 square miles (1,620 km2); this comprises 599.59 square miles (1,552.9 km2) of land and 22.3 square miles (58 km2) covered by water. The Piney Woods are north of Houston. Most of Houston is located on the gulf coastal plain, and its vegetation is classified as temperate grassland and forest. Much of the city was built on forested land, marshes, swamp, or prairie and are all still visible in surrounding areas.[citation need...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for PROVIDER NETWORK MANAGER jobs
$107,998 to $135,315
Houston, Texas area prices
were up 2.3% from a year ago
were up 2.3% from a year ago
What does a PROVIDER NETWORK MANAGER do?
PROVIDER NETWORK MANAGER in Lafayette, LA
NCQA Provider Network Accreditation creates a framework for organizations to provide efficient, accurate and consistent network management and credentialing services.
December 25, 2019
PROVIDER NETWORK MANAGER in Saginaw, MI
A crucial part of this effort is educating our providers about our plans, particularly our insurance benefits and workers’ compensation plans, and how to navigate the claims process for each one.
February 21, 2020
PROVIDER NETWORK MANAGER in Elkhart, IN
We offer providers a value-based reimbursement model centered on aligning quality measures, HEDIS measures and HH incentives to reward high-quality care of the members you serve.
January 03, 2020