Medical Network Provider Relations Manager

requirements. Network Management and Development Support provider recruitment, onboarding, and retention initiatives. Partner with Contracting and Network Development teams to identify network gaps and expansion opportunities. Assist with implementation of provider contracts and network participation agreements. Monitor provider performance and participation to ensure network adequacy and service excellence. Provider Education and Communication Develop and deliver provider education programs regarding claims submission, reimbursement methodologies, policies, and operational processes. Communicate organizational updates, policy changes, and regulatory

requirements to participating providers. Create and distribute provider newsletters, training materials, and communication resources. Facilitate provider meetings, webinars, and network forums. Performance Analysis and Reporting Analyze provider performance metrics, service trends, and network utilization data. Develop reports and presentations for leadership regarding provider network performance and relationship management activities. Monitor key performance indicators (KPIs) such as provider satisfaction, issue resolution, and retention rates. Identify opportunities for process improvements and operational efficiencies. Cross-Functional Collaboration Collaborate with Claims, Contracting, Credentialing, Provider Data Management, Operations, and Client Services teams. Act as a provider advocate within the organization to ensure provider perspectives are considered in decision-making. Participate in client meetings and strategic initiatives involving provider network management. Support implementations, acquisitions, network expansions, and special projects. Compliance and Quality Assurance Ensure provider interactions and activities comply with contractual obligations, regulatory

requirements, and company policies. Ensure provider interactions comply with rented network guidelines and contractual obligations. Support internal and external audits related to provider network management. Maintain accurate documentation of provider communications, escalations, and resolutions. Promote compliance with network standards and performance expectations. Required

Qualifications : Bachelor's degree in Healthcare Administration, Business Administration, Healthcare Management, or a related field. Minimum 5 years of experience in provider relations, healthcare network management, account management, managed care, or healthcare operations. Strong knowledge of: Healthcare provider networks Claims processing and reimbursement methodologies Provider contracting and credentialing Managed care operations Healthcare regulations and compliance

requirements Experience managing provider relationships and resolving complex provider issues. Excellent communication, negotiation, presentation, and interpersonal skills. Strong analytical and problem-solving abilities. Proficiency with Microsoft Office Suite and CRM or provider management systems. Preferred

Qualifications : Experience within a Third-Party Administrator (TPA), PPO network, health plan, managed care organization, or healthcare services company. Knowledge of workers’

compensation and medical-only network programs. Experience supporting nationwide provider networks. Familiarity with provider data management, network rental arrangements, and claims repricing operations. Professional certifications such as Certified Provider Relations Professional (CPRP) or related healthcare certifications. New York, NY Salary Range $126,800 — $158,500 USD Denver, CO Salary Range $116,000 — $145,000 USD Charlotte, NC Salary Range $105,600 — $132,000 USD All employees are responsible for adherence to the Judi Health Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and

responsibilities as needed to best meet organizational goals. We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at https://www.judi.health/legal/privacy-policy .

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