Network Manager

Overview Job Number: 178906, Job Title: Network Manager. Salary: $80,000.00 - $100,000.00. Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance.

Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs: Medicaid STAR for low-income children and pregnant women; CHIP for the children of low-income parents (including CHIP Perinatal benefits); Health Insurance Marketplace Plans; and Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan. Community is accredited by URAC for its health plan operations and offers care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System, Community is financially self-sufficient with no financial support from Harris Health or Harris County taxpayers.

Position Summary The Network Manager is responsible for network development and management, expanding provider networks for existing and new lines of business, negotiating provider agreements, ensuring regulatory compliance, and maintaining effective relationships with providers. The Provider Network Manager collaborates with internal departments to achieve departmental goals and contribute to the organization’s success. Responsibilities Negotiate provider contracts and contract language and rates with hospital, physician, ancillary, and LTSS providers in accordance with established parameters and guidelines.

Collaborate with Compliance, Legal, and Credentialing teams to finalize provider contracts, including amendments and new agreements. Ensure compliance with regulatory and product requirements related to provider contracting, including network adequacy standards. Expand provider networks for existing and new lines of business; conduct external meetings with prospective and existing providers to negotiate or renegotiate agreements.

Collaborate with relevant teams to facilitate network expansion efforts. Ensure compliance and network adequacy, monitor regulatory standards, and coordinate with Network Management, Claims, and Provider Data Integrity teams to ensure accurate contract reimbursement and adherence to requirements. Actively contribute to departmental goals as outlined in the annual business plan and participate in process improvement initiatives.

Serve as a liaison between Community Health Choice and its providers, address issues, resolve problems, and maintain positive provider relationships. Perform other duties as assigned to support the department’s functioning. Qualifications Education/Specialized Training/Licensure: Bachelor’s degree; or 7 years of experience in lieu of degree (equivalent combination of education and minimum experience).

Work Experience: Minimum of three (3) years in healthcare, providers/managed care, contracting, and relations with degree; or a minimum of seven (7) years without degree. Management Experience: Not applicable. Software Proficiencies: Microsoft Office (Word, Excel, Outlook).

Other: Must have a vehicle and a valid State of Texas Driver’s License. Must have managed care contract negotiation experience, preferably in the Houston market. Experience with Star Plus, LTSS, HCBPs, and Medicare products is a plus. #J-18808-Ljbffr