Sr. Managed Care Network Manager in United States at Jobgether

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Sr. Managed Care Network Manager based in United States.

In this role, you will serve as a key driver of managed care network performance and provider relations strategy, ensuring effective coordination between health plans, provider groups, and internal stakeholders. You will play a central role in implementing managed care agreements, optimizing network operations, and supporting the seamless integration of acquired and affiliated provider groups. The position blends strategic contract management with hands-on operational problem-solving, requiring close collaboration with clinical, administrative, and insurance partners. You will also contribute to strengthening payer relationships, improving reimbursement outcomes, and ensuring compliance across managed care arrangements. Operating in a highly collaborative healthcare environment, you will help shape more efficient, patient-centered network systems while supporting continuous improvement initiatives. This is a highly visible role that combines analytical thinking, negotiation expertise, and cross-functional coordination within a mission-driven organization.

• Coordinate and implement managed care plans by working closely with internal teams, provider groups, and external health plan partners to ensure effective execution of network strategies.
• Lead provider group transitions, including acquired and affiliated organizations, ensuring smooth onboarding and alignment with managed care requirements.
• Develop and maintain strong relationships with managed care plans through consistent communication, negotiation, and partnership management.
• Negotiate contract terms, amendments, and agreements with payers to achieve favorable reimbursement and operational outcomes.
• Monitor managed care plan performance to ensure compliance, efficiency, and alignment with organizational objectives.
• Support resolution of escalated issues, claims payment challenges, and operational concerns related to managed care contracts.
• Coordinate provider credentialing processes for affiliated and acquired groups within managed care networks.
• Facilitate training and education for provider leadership on managed care policies, procedures, and requirements.
• Collaborate with stakeholders to address clinical, operational, and claims-related issues and ensure timely resolution.
• Contribute to continuous improvement initiatives aimed at enhancing managed care operations and network effectiveness.
• Review and evaluate managed care proposals to ensure alignment with organizational goals and financial targets.
• Perform additional duties as needed to support managed care network performance and organizational success.

• Bachelor’s degree in Healthcare, Business, or a related field (Master’s preferred).
• 7+ years of experience in healthcare, insurance, provider relations, or managed care environments.
• Strong experience in provider network management, contract negotiation, and contract administration.
• Solid understanding of medical terminology, CPT coding, and reimbursement methodologies.
• Proven ability to negotiate and manage complex payer contracts and amendments.
• Experience working with provider groups, health plans, and healthcare delivery systems.
• Strong analytical, organizational, and problem-solving skills with the ability to manage multiple priorities.
• Excellent verbal and written communication skills with the ability to engage clinical, administrative, and executive stakeholders.
• Proficiency in Microsoft Office Suite, including Excel and Access, with strong overall computer literacy.
• Ability to work independently in a remote environment while managing deadlines and variable schedules.
• Strong interpersonal skills with the ability to build trust and collaborate across diverse healthcare stakeholders.
• Experience in training, education, or change management within provider or payer environments is a plus.

• Competitive salary range: $66,170.74 – $123,073.07 annually (based on experience and qualifications).
• Comprehensive medical, dental, and vision insurance coverage.
• Life insurance and disability coverage provided.
• Paid time off starting from day one.
• 403(b) retirement savings plan.
• 100% paid parental leave (4 weeks).
• Career development and internal growth opportunities.
• Mental health resources and employee wellness support programs.
• Pet benefits and additional lifestyle perks.
• Flexible work arrangements with fully remote options.
• Inclusive, mission-driven environment focused on whole-person well-being.