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Remote Provider Network Development information

What are some common challenges faced by professionals in Remote Provider Network Development roles and how can they be addressed?

One of the main challenges in Remote Provider Network Development is building strong relationships with providers and stakeholders without regular face-to-face interaction. This requires effective virtual communication skills and the ability to leverage digital collaboration tools. Additionally, navigating differing regulations and provider expectations across regions can be complex, so staying organized and informed about local requirements is crucial. Proactively scheduling regular check-ins and utilizing centralized documentation can help maintain alignment and foster trust among network partners.

What is the difference between Remote Provider Network Development vs Remote Provider Relations Specialist?

AspectRemote Provider Network DevelopmentRemote Provider Relations Specialist
Primary FocusBuilding and expanding provider networks, negotiating contractsManaging existing provider relationships, resolving issues
Required CredentialsHealthcare administration, insurance, or related certificationsCustomer service, healthcare administration certifications
Work EnvironmentStrategic planning, cross-department collaborationProvider communication, issue resolution
Industry UsageHealth insurance companies, managed care organizations

Remote Provider Network Development focuses on expanding and negotiating provider networks, while Remote Provider Relations Specialists manage ongoing provider relationships and address issues. Both roles require healthcare or insurance knowledge but differ in their strategic versus operational focus.

What is a Remote Provider Network Development specialist?

A Remote Provider Network Development specialist is responsible for identifying, recruiting, and managing healthcare providers to join a health plan’s network, all while working remotely. They negotiate contracts, ensure providers meet quality standards, and maintain strong relationships to ensure network adequacy. This role often involves analyzing data to identify network gaps and collaborating with internal teams to address member needs. Remote work allows these specialists to connect with providers across various regions without needing to be on-site.

What are the key skills and qualifications needed to thrive as a Remote Provider Network Development professional, and why are they important?

To excel in Remote Provider Network Development, you need expertise in healthcare network management, contract negotiation, and provider relations, often supported by a bachelor’s degree in healthcare administration or a related field. Familiarity with health plan software, CRM tools, and knowledge of regulatory compliance systems are typically required. Strong communication, relationship-building, and problem-solving skills are essential for establishing and maintaining provider partnerships. These skills ensure effective network expansion, regulatory compliance, and high-quality service for health plan members.
What are the most commonly searched types of Provider Network Development jobs in Michigan? The most popular types of Provider Network Development jobs in Michigan are:
What are popular job titles related to Remote Provider Network Development jobs in Michigan? For Remote Provider Network Development jobs in Michigan, the most frequently searched job titles are:
What job categories do people searching Remote Provider Network Development jobs in Michigan look for? The top searched job categories for Remote Provider Network Development jobs in Michigan are:
What cities in Michigan are hiring for Remote Provider Network Development jobs? Cities in Michigan with the most Remote Provider Network Development job openings:
Remote Provider Network Development jobs near you
Provider Practice Performance Advisor

Provider Practice Performance Advisor

Amerihealth Caritas

Southfield, MI • On-site, Remote

Full-time

Posted 17 days ago

AmeriHealth Caritas rating

8.5

Company rating: 8.5 out of 10

Based on 69 frontline employees who took The Breakroom Quiz

86th of 261 rated insurance

Job description

Role Overview: The Performance Practice Advisor supports the Provider Network Management (PNM) team within a POD-based staffing care model, focusing on provider performance, value-based care (VBC) initiatives, and quality outcomes. This role analyzes provider performance data, identifies improvement opportunities, and partners with providers and internal teams to drive improvements in quality, cost, and overall care delivery.

Work Arrangements:

  • Remote – The associate can be located anywhere in Michigan (MI).
  • 50% travel is required to the provider’s location and attend office meetings at our Southfield, MI location.

Responsibilities:

  • Produce all quality and performance-related reporting, establishing opportunities and strategies regularly in preparation for the Joint Operating Committee (JOC).
  • Present information to the provider, colleagues, and the executive team in a clear, concise manager
  • Analyze claims data, utilization trends, and patient outcomes to support performance optimization
  • Support provider engagement related to Healthcare Effectiveness Data and Information Set (HEDIS), Total Cost of Care (TCOC), and other performance-based programs
  • Partner with Quality, Provider Network, and Account Executive teams to align strategies and improve provider performance
  • Participate in provider meetings to review gaps in care and develop action plans in collaboration with Provider Network Management (PNM) and Chief Medical Officer (CMO) teams
  • Lead and support performance improvement initiatives and projects aligned with corporate strategy and best practices
  • Identify opportunities using data and collaborate with internal teams to develop and implement targeted intervention strategies
  • Track, monitor, and report on provider action plans and outcomes to measure the effectiveness of initiatives
  • Support network and quality strategy execution across markets
  • Maintain strong cross-functional collaboration with Provider Network Operations (PNO), PNM, and Quality teams to achieve performance goals
  • May assist with member outreach efforts and coordination of care-related activities

Education & Experience:

  • Bachelor’s degree in healthcare administration or related field required
  • 3 years of Account Executive experience or provider engagement experience, demonstrating knowledge of TCOC and Medical Loss Ratio (MLR) analysis, is required.
  • Experience in a variety of provider reimbursement methodologies, including value-based or risk-based contracting
  • Understand quality and provider performance reporting, including HEDIS and other quality measures.

Licensure:

  • Valid driver's license, transportation, and insurance required:

Skills & Abilities:

  • Strong understanding of healthcare regulations, reimbursement models, and quality metrics, specifically in HEDIS and STARS
  • Ability to analyze and interpret complex healthcare data and translate insights into actionable strategies
  • Knowledge of provider operations, including claims coding, payment integrity, credentialing, appeals, and disputes
  • Experience working with value-based care programs and performance measures
  • Excellent communication and collaboration skills with the ability to engage providers and cross-functional teams
  • Strong analytical, problem-solving, and reporting capabilities
  • Ability to manage multiple priorities and drive performance improvement initiatives

What AmeriHealth Caritas employees say

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