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Remote Provider Network Development Jobs in Tennessee

Abilis Health Plan

Provider Network Manager

Nashville, TN · On-site +1

$70K - $80K/yr

Five (5)+ years of experience in managed care, provider network development, provider relations, contracting, or a related healthcare field. * Prior experience with Medicare Advantage plans required;

Abilis Health Plan

Provider Network Manager

Memphis, TN · On-site +1

$70K - $80K/yr

Five (5)+ years of experience in managed care, provider network development, provider relations, contracting, or a related healthcare field. * Prior experience with Medicare Advantage plans required;

CareAllies

Network Ops Coordinator II

Nashville, TN · On-site +1

$47K - $86K/yr

We empower employees with curated development plans that foster growth and promote rewarding ... Building relations with the Provider community is an important part of this role. Responsibilities ...

SpaceXAI

Network Engineer

Memphis, TN · Remote

... provides a reliable, high-performance and secure network behind one of the few products in the ... Liaise with third parties, IT and remote office users to fix and resolve issues * Creation and ...

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Remote Provider Network Development information

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 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 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 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 are the most commonly searched types of Provider Network Development jobs in Tennessee?

The most popular types of Provider Network Development jobs in Tennessee are:

What are popular job titles related to Remote Provider Network Development jobs in Tennessee?

For Remote Provider Network Development jobs in Tennessee, the most frequently searched job titles are:

What job categories do people searching Remote Provider Network Development jobs in Tennessee look for?

The top searched job categories for Remote Provider Network Development jobs in Tennessee are:

What cities in Tennessee are hiring for Remote Provider Network Development jobs?

Cities in Tennessee with the most Remote Provider Network Development job openings:

Remote Provider Network Development jobs near you

Provider Network Manager

Abilis Health Plan

Nashville, TN • On-site, Remote

$70K - $80K/yr

Full-time

Medical

Posted 7 days ago

Job description

Our Company

Abilis Health Plan

Overview

The Provider Network Manager is responsible for maintaining and enhancing provider networks within an assigned territory through provider relations, network development, and routine contracting activities. The Provider Network Manager serves as a primary contact for contracted providers, conducts provider education and outreach, identifies and addresses network opportunities, and supports provider recruitment efforts. The position also monitors market changes and network performance to ensure adequate provider coverage and compliance with CMS network adequacy standards and all applicable regulatory requirements.

Responsibilities
  • Manage provider relationships within assigned markets, serving as a primary point of contact for contracted providers and addressing network-related issues and inquiries.
  • Perform routine provider contracting and recruitment activities to support network growth, address coverage gaps, and maintain adequate provider access.
  • Conduct provider education and outreach activities to promote provider engagement, communication, and understanding of health plan requirements and initiatives.
  • Monitor and report market and provider changes that may impact network performance, access, or compliance within assigned territories.
  • Collaborate with internal departments to resolve provider issues, support operational initiatives, and improve network effectiveness.
  • Promote a positive and collaborative work environment that supports continuous improvement and organizational success.
  • Complete all assigned corporate responsibilities, including compliance training and other organizational requirements.
Qualifications
  • Associate's Degree or equivalent work experience.
  • Five (5)+ years of experience in managed care, provider network development, provider relations, contracting, or a related healthcare field.
  • Prior experience with Medicare Advantage plans required; Institutional Special Needs Plan (I-SNP) experience preferred.
  • Experience building and maintaining provider relationships, conducting provider education, and supporting provider engagement initiatives.
  • Reliable transportation.
  • Current automobile insurance which meets company policy requirements.
  • Familiarity with health plan operations, including benefits, claims review and resolution, eligibility, provider data management, and network operations.
  • Knowledge of CMS network adequacy standards, provider recruitment, and regulatory compliance requirements preferred.
  • Strong organizational, presentation, and time management abilities.
  • Effective communication skills.
  • Working knowledge of Medicare payment methodologies.
  • Ability to follow instructions and work independently to achieve goals and complete assignments.
  • Proven success working collaboratively in a team environment.
  • Proficient in Microsoft Office Suite and other relevant computer applications.
  • Self-motivated, dependable, team-oriented, and goal-oriented.
  • Skilled at managing multiple priorities effectively.
  • Travel up to 25%
About our Line of BusinessAbilis Health Plan, an affiliate of BrightSpring Health Services, is a Medicare Advantage Plan covering all the benefits of Original Medicare (Parts A and B) with prescription drug coverage (Part D). The Abilis Health Plan is a unique plan allowing members to enroll year-round. The plan focuses on members who meet residential requirements in participating nursing facilities. An interdisciplinary team of clinicians and innovative services allow us to meet each member's clinical needs and provide preventive, coordinated, and quality healthcare. With a dedicated nurse practitioner leading a personalized care plan, we strive to improve the health of the communities in which we serve. For more information, please visit www.abilishealth.com. Follow us on LinkedIn.Salary RangeUSD $70,000.00 - $80,000.00 / YearEmployment Type: FULL_TIME

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