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The Network Management Consultant supports the Senior Manager in advancing provider network performance across Medicare Advantage markets with a focus on quality improvement, risk adjustment optimization, and value-based care initiatives. This role collaborates with internal teams and external provider partners to implement strategies that improve clinical quality outcomes, coding accuracy, and overall network performance. The consultant assists in provider engagement, performance analysis, and operational execution of programs that support risk capture, quality ratings, and regulatory compliance within the Medicare Advantage line of business.
Job Responsibility:
Supports the Senior Manager in advancing provider network performance across Medicare Advantage markets with a focus on quality improvement, risk adjustment optimization, and value-based care initiatives
Collaborates with internal teams and external provider partners to implement strategies that improve clinical quality outcomes, coding accuracy, and overall network performance
Assists in provider engagement, performance analysis, and operational execution of programs that support risk capture, quality ratings, and regulatory compliance within the Medicare Advantage line of business
Requirements:
Bachelor’s Degree and at least one year experience developing and negotiating provider contracts OR 5 years managed care operations experience handling independent work with at least one year experience developing and negotiating provider contracts
Meet deadlines and work well under pressure
Verbal and written communication skills, organizational and planning skills
PC proficiency to include Microsoft Office
Analytical skills
Ability and willingness to travel within assigned territory, including overnight stays
Nice to have:
Bachelor’s Degree in Business
What we offer:
Curated development plans that foster growth and promote rewarding, fulfilling careers