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Remote Provider Network Management Jobs in Michigan

Nityo Infotech

Network Cloud Engineer

Ann Arbor, MI · Remote

Remote- Michigan Duration: Long Term This role will provide design and architecture for the network infrastructure and services (InterConnect, Bastion Services, VPC Peering, etc.) for GCP cloud ...

Nityo Infotech

Network Cloud Engineer

Ann Arbor, MI · On-site +1

Remote- Michigan Duration: Long Term • This role will provide design and architecture for the network infrastructure and services (InterConnect, Bastion Services, VPC Peering, etc.) for GCP cloud ...

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Remote Provider Network Management information

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

To thrive in Remote Provider Network Management, you need expertise in healthcare provider relations, contract negotiation, and a solid understanding of health plan regulations, often supported by a degree in healthcare administration or a related field. Familiarity with provider network management software, data analytics tools, and knowledge of regulations like HIPAA are typically required. Excellent communication, problem-solving abilities, and attention to detail are essential soft skills for building strong partnerships and managing network performance. These skills and qualifications ensure efficient network operations, regulatory compliance, and high-quality service for both providers and members.

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

AspectRemote Provider Network ManagementRemote Provider Relations Specialist
CredentialsHealthcare administration, network management certificationsCustomer service, healthcare communication certifications
Work EnvironmentHealthcare organizations, insurance companies, remote office settingsHealthcare providers, insurance companies, remote customer support
Industry UsageManaging provider networks, credentialing, contractingBuilding provider relationships, resolving provider issues

Remote Provider Network Management focuses on overseeing healthcare provider networks, including credentialing and contracting. In contrast, Remote Provider Relations Specialists primarily handle communication and relationship-building with providers. Both roles require healthcare knowledge but differ in their core responsibilities and focus areas.

How does a Remote Provider Network Management professional typically collaborate with healthcare providers and internal teams?

Remote Provider Network Management professionals frequently coordinate with healthcare providers via virtual meetings, emails, and secure online portals to address contract negotiations, credentialing, and performance issues. They also work closely with internal departments such as claims, quality assurance, and customer service to ensure seamless provider onboarding and ongoing support. Effective communication and strong relationship-building skills are essential, as much of the collaboration happens through digital channels. This setup allows for flexibility but requires self-motivation and proactive engagement to maintain strong provider networks.

What is a Remote Provider Network Management role?

A Remote Provider Network Management role involves overseeing relationships and contracts with healthcare providers, such as doctors, hospitals, and clinics, while working remotely. Professionals in this field are responsible for recruiting new providers, maintaining communication, ensuring compliance with regulations, and addressing network issues. They play a key part in expanding and maintaining a healthcare organization's provider network to ensure members have access to quality care. This job typically requires strong organizational, negotiation, and communication skills, as well as familiarity with healthcare regulations and provider credentialing processes.
What are the most commonly searched types of Provider Network Management jobs in Michigan? The most popular types of Provider Network Management jobs in Michigan are:
What are popular job titles related to Remote Provider Network Management jobs in Michigan? For Remote Provider Network Management jobs in Michigan, the most frequently searched job titles are:
What job categories do people searching Remote Provider Network Management jobs in Michigan look for? The top searched job categories for Remote Provider Network Management jobs in Michigan are:
What cities in Michigan are hiring for Remote Provider Network Management jobs? Cities in Michigan with the most Remote Provider Network Management job openings:
Remote Provider Network Management jobs near you
Provider Practice Performance Advisor

Provider Practice Performance Advisor

Amerihealth Caritas

Southfield, MI • On-site, Remote

Full-time

Re-posted 12 days ago

AmeriHealth Caritas rating

8.3

Company rating: 8.3 out of 10

Based on 72 frontline employees who took The Breakroom Quiz

110th of 281 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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