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Remote Provider Network Development Jobs in New York

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Oyster Bay, NY · Remote

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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 New York? The most popular types of Provider Network Development jobs in New York are:
What are popular job titles related to Remote Provider Network Development jobs in New York? For Remote Provider Network Development jobs in New York, the most frequently searched job titles are:
What job categories do people searching Remote Provider Network Development jobs in New York look for? The top searched job categories for Remote Provider Network Development jobs in New York are:
What cities in New York are hiring for Remote Provider Network Development jobs? Cities in New York with the most Remote Provider Network Development job openings:
Remote Provider Network Development jobs near you

Senior Specialist, Network Compliance Oversight - Remote

EmblemHealth

New York, NY • On-site, Remote

$68K - $118K/yr

Full-time

Posted 14 days ago

EmblemHealth rating

9.4

Company rating: 9.4 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

7th of 301 rated insurance

Job description

Summary of Job
Ensure compliance of all regulatory mandated print directory and associated materials for the company's provider network. Facilitate updates to the print Provider Network Directory to ensure it is accurate, up-to-date, and complete: responsible for development to production for all lines of business; serve as a subject matter expert providing feedback, recommendations, analysis and development from inception to completion. Collaborate on Provider Network regulatory communications as well as Vendor and Delegate oversight.
Responsibilities
  • Participate in all phases of project planning and process management of the printed provider network directory updating; ensure that all materials are current, accurate, and in compliance with all applicable regulations.
  • Serve as the Subject Matter Expert for print provider network directory development and production for all products; provide guidance on regulatory requirements for directory accuracy and inclusion of compliance requirements.
  • Perform research, comparisons, audits, and analysis; define process and project needs in terms of scope, timelines, deliverables, stakeholders, resource allocation, etc.
  • Build rapport with and influence stakeholders for effective cross-functional and department collaboration; organize different individuals, stakeholders, and business leaders (internally and externally) around shared goals.
  • Work with project team members to manage information outreach, including specific objectives, timelines, and key deliverables. Follow through on defined directory production scope by developing timelines, objectives, deliverables, and project plans; providing updates (including dashboards and tracking documents) on progress status and risks to ensure that directory production stays on track.
  • Provide feedback on progress of projects, regularly providing recommendations; compile and present results of analyses to appropriate parties; and develop and prepare materials that reflect progress and track the printed directory production.
  • Work with the Product teams to manage the production for all lines of business and for implementing and maintaining the requirements of the printed directory production for each product; and memorialize each production.
  • Serve as the primary contact with third party vendors that produce the printed directories.
  • Facilitate the transfer of data files from EmblemHealth systems to the vendors.
  • Work with IT throughout the print production process to ensure timely and accurate file transfers.
  • Responsible for Provider Network regulatory communications to include reviewing reports from regulatory entities (i.e. DOH, CMS, etc.) noting deficiencies and facilitate information gathering, remediation, and draft response to the regulatory entity. This includes outreach within PNPH, creating and managing trackers, and ensuring timely and complete responses for executive signature and submission to regulators.
  • Receive and facilitate responses to regulatory reports, inquiries, and standard data submissions.
  • Identify, anticipate, prevent, and mitigate/resolve issues and obstacles that impede project completion.
  • Memorialize responses; create and maintain trackers of all reports and responses. Monitor trends and repeat findings to establish root causes.
  • Support and monitor the organization's delegated vendors and providers to ensure contract, Quality, and regulatory compliance.
  • Maintain the oversight structure for delegated and other key vendors by managing the SharePoint site, facilitating annual updates of the oversight documents and processes, and auditing for completeness and accuracy to support NCQA and regulatory audits and exams.
  • Coordinate the bi-monthly Delegate and Vendor Oversight Committee meeting; ensure proper documentation of oversight activities. Maintain the oversight structure for delegated and other key vendors by managing the SharePoint site, facilitating annual updates of the oversight documents and processes, and auditing for completeness and accuracy to support NCQA and regulatory audits and exams.

Qualifications
  • Bachelor's Degree
  • 4 - 6+ years of relevant professional work experience (Required)
  • Ability to accurately produce network provider information for a healthcare organization on an ongoing basis (Required)
  • Demonstrated track record in information gathering, project managing and information tracking (Required)
  • Proven ability to manage multiple tasks/projects/priorities with competing deadlines successfully (Required)
  • Knowledge of healthcare regulatory guidelines related to provider network directory production (Required)
  • Ability to work with teams across the organization and outside vendors (Required)
  • Excellent communication skills (verbal, written, presentation, interpersonal) with all types/levels of audiences (Required)
  • Strong organizing, prioritizing, and project management skills (Required)
  • Proficiency with MS Office - Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc. (Required)
  • Working knowledge of Adobe, as well as ability to learn proprietary systems (Required)

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