The Provider Network Operations Manager supports the Director of Provider Network Operations in the strategic and operational oversight of Provider Relations and PN Operations and Service Development teams. This position is responsible for managing supervisor-level staff, driving operational excellence, supporting provider network initiatives, improving processes, and ensuring effective collaboration across departments. The Manager partners with leadership to develop standardized workflows, improve efficiency, enhance team performance, and support organizational goals related to provider engagement, network adequacy, and operational effectiveness.
This position is fulltime remote. Selected candidate must reside in North Carolina. Some travel for onsite meetings to the Home office at Morrisville may be required.
Responsibilities & Duties
Manage Unit Operations
- Support the Director of Provider Network Operations in overseeing daily operations of Provider Relations and PN Operations and Service Development teams
- Monitor team performance, service metrics, and operational outcomes
- Ensure operational priorities align with organizational goals and strategic initiatives
- Assist with planning, implementation, and evaluation of department objectives
- Directly supervise Provider Relations Supervisor and Supervisor PN Operations and Service Development
- Provide coaching, mentorship, and performance management to supervisory staff
- Promote a culture of accountability, collaboration, customer service, and continuous improvement
- Support workforce planning, staff development, succession planning, and employee engagement initiatives
- Partner with supervisors to identify training needs and professional development opportunities
- Identify opportunities to streamline workflows and improve operational efficiency
- Develop, implement, and monitor standardized processes, tools, and procedures across Provider Relations and PN Operations and Service Development functions
- Collaborate with supervisors and staff to evaluate operational challenges and implement sustainable solutions
- Recommend process improvement initiatives that reduce administrative burden, improve consistency, and increase effectiveness
- Measure and report on the effectiveness of process improvement initiatives
Staff Management and Development
- Work with Human Resources and the Director of Provider Network Operations to attract, maintain, and retain a highly qualified and well-trained workforce
- Ensure staff are well trained in and comply with all organization and department policies, procedures, and business processes
- Organize workflows and ensure staff understand their roles and responsibilities
- Ensure the department has the needed tools and resources to achieve organizational goals and to support employees and ensure compliance with licensure, regulatory, and accreditation requirements
- Actively establish and promote a positive, diverse, and inclusive working environment that builds trust
- Ensure all staff are treated with respect and dignity
- Ensure standards are transparent and applied consistently, impartially, and ethically over time and across all staff members
- Work to resolve conflicts and disputes, ensuring that all participants are given a voice
- Set goals for performance and deadlines in line with organization goals and vision
- Effectively communicate feedback and provide ongoing coaching and mentoring to staff and support a learning environment to advance team skills and professional development
- Cultivate and encourage efforts to expand cross-team collaboration and partnership
Manage and Analyze Reports
- Develop and analyze operational reports, dashboards, and performance metrics
- Monitor departmental goals and key performance indicators
- Provide recommendations to the Director of Network Operations regarding operational improvements and strategic opportunities
- Ensure compliance with organizational policies, documentation standards, and regulatory requirements
Collaborate with Internal Departments
- Partner with Contracting, Claims, Quality, Care Management, Finance, and other departments to support provider and operational needs
- Facilitate communication and coordination between teams to address system and process issues
- Participate in organizational initiatives impacting provider network performance and operations
Manage Projects
- Take a lead role with special projects related to provider relations, operations and development
- Assist Director Provider Network Operations with development of project action plans, participate in special projects as needed to evaluate operational requirements
Minimum Requirements
Education & Experience
Bachelor’s degree from an accredited college or university in a Human Services, Education, Sociology, Business, Public Administration, or related field and seven (7) years of experience in community, business, or governmental programs in health related fields, including two years of supervisory, consultative or administrative experience.
Prior experience with Standard Plan or Tailored Plan preferred.
Or
Master’s degree from an accredited college or university in a Human Services, Education, Sociology, Business, Public Administration, or related field and three (3) years of experience in community, business, or governmental programs in health related fields, including two years of supervisory, consultative or administrative experience.
Prior experience with Standard Plan or Tailored Plan preferred.
Knowledge, Skills, & Abilities
- General knowledge of Provider Contract requirements
- General healthcare knowledge
- Knowledge of database systems for reporting and transmission of data
- Thorough knowledge of Microsoft Office Suite, particularly MS Word and MS Excel
- Strong interpersonal skills with ability to communicate with appropriate staff
- Demonstrated supervision skills
- Problem solving skills
- Ability to identify and correct credentialing reporting issues via Microsoft Excel and credentialing database
- ability to manage several projects
- Ability to prepare technical reports
Salary Range
$103,799-$132,344/Annually
Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity.
An excellent fringe benefit package accompanies the salary, which includes:
- Medical, Dental, Vision, Life, Long Term Disability
- Generous retirement savings plan
- Flexible work schedules including hybrid/remote options
- Paid time off including vacation, sick leave, holiday, management leave
- Dress flexibility
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