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Remote Provider Network Management Jobs in Tennessee

Abilis Health Plan

Provider Network Manager

Nashville, TN · On-site +1

$70K - $80K/yr

The Provider Network Manager serves as a primary contact for contracted providers, conducts ... Strong organizational, presentation, and time management abilities. * Effective communication ...

Abilis Health Plan

Provider Network Manager

Memphis, TN · On-site +1

$70K - $80K/yr

The Provider Network Manager serves as a primary contact for contracted providers, conducts ... Strong organizational, presentation, and time management abilities. * Effective communication ...

SpaceXAI

Network Engineer

Memphis, TN · Remote

... provides a reliable, high-performance and secure network behind one of the few products in the ... Provisioning and management of corporate circuits * Contribute to the continuous improvement of ...

Rentokil

IT Infrastructure Engineer

Memphis, TN · Remote

Reporting directly to the Network Manager, this role is a critical network-centric position that ... Ensure all configured remote hardware, branch move network equipment, and access points are ...

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Remote Provider Network Management information

What is remote provider network management?

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 key skills and qualifications needed to thrive as a remote provider network management professional?

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.

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 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.

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

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

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

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

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

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

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

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

Remote Provider Network Management jobs near you

Provider Network Manager

Chattanooga, TN • On-site, Remote

Abilis Health Plan
See more jobs at Abilis Health Planexternal

$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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