Manager, Network Development

Manager, Network Development

The Manager, Network Development is responsible for building and maintaining a robust, competitive, compliant, and accessible provider network across current and expansion service areas. This role oversees a team of network development specialists and works collaboratively to ensure the provider network meets Pennsylvania DHS, PID, CMS and other applicable regulatory adequacy requirements, while also supporting strategic growth and provider satisfaction.

Essential Functions :

• Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.
• Develop and implement network expansion strategies aligned with access standards and regional adequacy goals, including time-and-distance and provider-to-member ratio metrics
• Monitor and report on network adequacy and provider participation to meet regulatory submission timelines.
• Lead and manage a team of network development staff to execute contracting and network development initiatives throughout the current servicing area, and future expansion areas.
• Negotiate provider agreements with independent physicians, and other ancillary partners to support Medicaid, CHIP, Medicare, Exchange and other lines of business.
• Partner with Credentialing, Provider Relations, Compliance, Analytics and other internal areas to streamline provider onboarding and ensure accurate, up-to-date provider data for state submissions.
• Collaborate with internal stakeholders to support growth strategies and expansion.
• Support annual readiness reviews, corrective action plans (CAPs), audits, and RFP-related network development tasks.
• Foster strong provider relationships that support collaborative care, reduce abrasion, and promote value-based care initiatives where applicable.
• Perform other duties as assigned.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Competencies (Knowledge, Skills, and Abilities Required) :

Minimum Education and Experience Requirements :

Education :

AND

Experience :

Compliance Statement : Compliance with all applicable rules, regulations and laws is a condition of employment. Employees must read and sign the Code of Conduct and be expected to perform their duties ethically and honestly.