Provider Network Management Specialist Senior

Provider Network Strategy Manager

Drive provider network strategies and solutions to improve outcomes and decrease medical expense trends. Develop and implement network engagement strategies linking strategic goals to the execution and renewal of alternative payment model contracts, through medical expense and utilization oversight of trend variance. Advance the requirements of business and quality improvement plans for assigned Accountable Care Networks and large practice groups.

Essential Functions :

• Responsible for contributing to the development and execution of provider strategy and solutions for assigned Accountable Care Networks.
• Substantially responsible for the execution of the strategy, including implementation of an annual strategic plan; coordinating and managing overall activities and developing strategies and approaches to help providers maximize performance potential.
• Provide relationship management and accountable care network oversight to support success in value-based contracts.
• Actively contribute to the Interdisciplinary Teams to ensure successful engagement of all parties.
• Lead the execution and implementation of payment programs, aligning economics with the business strategy to achieve lower per capita cost.
• Manage and implement programs to drive down total cost of care through utilization and medical expense trend oversight.
• Identify risk readiness for accountable care networks.
• Manage contract success through analysis of monthly reports.
• Provide mitigation solutions for gap closure and quality metric success.

Qualifications :