Provider Network Manager Jobs in Washington (NOW HIRING)

Company Overview

As one of the Washington metropolitan area's fastest-growing IT companies, Enlightened is always looking for creative, passionate, and responsible employees. We recognize that our intelligent and dedicated employees are our greatest asset, and we are continually expanding our talented and diverse team. If innovation, integrity, and a commitment to delivering exceptional results are key components of your success, we invite you to join Enlightened.

Work Arrangement

This is a hybrid position based in our Washington, DC office, conveniently located within walking distance of two Metro stations. Associates work four (4) days in the office and one (1) day remotely each week.

Position Summary

The Provider Network Account Executive is responsible for developing and maintaining strong relationships with healthcare providers to improve provider performance, engagement, and satisfaction. This role serves as a key liaison between the health plan and its contracted provider network, supporting providers participating in fee-for-service programs, including primary care physicians (PCPs), OB/GYNs, high-volume specialists, Federally Qualified Health Centers (FQHCs), and other provider organizations.

The Provider Network Account Executive partners with internal stakeholders to support network development initiatives, provider education, contract management, operational issue resolution, and provider performance improvement.

Responsibilities

• Support provider network development and network management strategies.
• Assist leadership with initiatives related to provider satisfaction, education, engagement, and communication.
• Support the organization's Single Case Agreement (SCA) strategy.
• Build, cultivate, and maintain strong relationships with contracted providers and provider organizations.
• Resolve provider concerns and disputes in a timely, professional, and compliant manner.
• Manage an assigned portfolio of provider accounts, including individual practices, multi-site practices, integrated delivery systems, and other healthcare organizations.
• Analyze provider performance data and implement strategies to strengthen provider relationships and improve outcomes.
• Conduct provider office visits and site visits as needed.
• Maintain a working knowledge of provider databases and communicate updates related to provider additions, terminations, and demographic changes.
• Collaborate effectively with internal departments including Claims, Provider Data Management, Credentialing, Payment Integrity, Contracting, Appeals, and other operational teams.
• Develop a strong understanding of provider contracts, performance expectations, and operational processes.
• Deliver provider orientation sessions, educational presentations, and ongoing training to support provider success.
• Recruit providers to address identified network adequacy gaps.
• Support provider contracting activities across multiple product lines, including:
  • Long-Term Services and Supports (LTSS)
  • Exchange Plans
  • Dual Special Needs Plans (D-SNP)
  • Fee-for-Service (FFS) agreements
• Support Value-Based Care (VBC) provider relationships and contract negotiations, as needed.

Education & Experience

• Associate degree required.
• Bachelor's degree preferred.
• One (1) or more years of experience as an Account Executive, Provider Relations Representative, Provider Network Specialist, or in a related healthcare provider relations role.
• Experience working with healthcare providers, managed care organizations, health plans, or provider networks preferred.
• Strong verbal and written communication skills with the ability to facilitate provider education, onboarding, presentations, and training sessions for both small and large audiences.
• Demonstrated ability to build collaborative relationships with providers and internal stakeholders.
• Strong organizational, analytical, and problem-solving skills.
• Proficiency using Microsoft Office and provider management systems is preferred.

Compensation

The anticipated hiring range for this position is $71,600 to $97,500 annually.

Benefits

The expected salary range for this position is listed above. Actual compensation will be determined based on experience and qualifications as well as internal equity and alignment with market data.

At Enlightened, we pride ourselves on offering a comprehensive and industry-competitive benefits package to our full-time employees. Our benefits include:

• Medical/Dental/Vision Insurance with Health Savings Accounts (HSA)
• Flexible Spending Accounts (FSA)
• 401(k) Retirement Plan
• Paid Holidays, Vacation, & Sick Leave
• Professional Training & Development Reimbursement

Please note, these benefits are available exclusively to full-time employees of Enlightened.

Equal Opportunity Statement

Enlightened is proud to be an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, disability, or any other federal, state, or local protected class.