Medical Network Relations Assistant Manager

Medical Network Relations Assistant Manager The Medical Network Assistant Manager is responsible for developing, managing, and maintaining relationships with healthcare providers (hospitals, clinics, physicians, and other health services). They ensure that the company’s provider network supports the delivery of high-quality care to its members while optimizing cost management. The role requires overseeing the negotiation of contracts, monitoring provider performance, and ensuring compliance with insurance policies and standards. This senior position also plays a pivotal role in strategic network expansion, addressing provider concerns, and enhancing overall network efficiency.

Key Responsibilities Provider Network Development

Lead efforts to develop, expand, and maintain a comprehensive network of healthcare providers across various regions.

Identify gaps in the provider network and develop strategies to fill those gaps to ensure adequate access to healthcare services.

Contract Negotiation and Management

Negotiate provider agreements, including fee schedules, contract terms, and service level agreements.

Monitor contract compliance, ensuring adherence to company policies, regulatory requirements, and financial targets.

Regularly review and update provider contracts to reflect changes in services, payment models, or regulatory standards.

Provider Relationship Management

Act as the primary liaison between the insurance company and network providers.

Develop and maintain positive relationships with key provider stakeholders to address any issues or concerns.

Organize meetings, workshops, and engagement initiatives to strengthen provider partnerships.

Building Relationships : Establishing and nurturing relationships with healthcare providers to facilitate communication and collaboration.

Performance Monitoring and Quality Assurance

Monitor provider performance using key metrics such as average cost, utilization rates, patient satisfaction, and clinical outcomes.

Collaborate with internal teams to address underperformance and improve service delivery.

Ensure healthcare providers meet the required quality standards, including compliance with regulatory and accreditation bodies.

Network Operations

Managing Daily Operations : Overseeing day-to-day functions and ensuring effective staff performance.

Evaluating team performance and implementing strategies for improvement.

Coordinating with internal departments to enhance provider engagement and service delivery.

Addressing provider inquiries and resolving complaints related to claims, eligibility, and reimbursement.

Strategic Planning and Expansion

Contribute to strategic initiatives to enhance network capabilities and expand into new regions or specialties.

Conduct market analysis to identify emerging healthcare providers and trends that align with business objectives.

Cost Management and Financial Oversight

Implement cost-containment strategies by negotiating favorable terms with providers and reviewing cost-effective care models.

Ensure alignment with the company’s financial goals by monitoring expenses related to the provider network.

Regulatory Compliance

Ensure all provider agreements and network operations comply with local, regional, and national healthcare regulations.

Stay up-to-date with changes in healthcare laws, insurance policies, and medical standards.

Education

Bachelor’s degree in Healthcare Administration, Business Administration, or a related field.

Experience

Minimum of 5 years of experience in healthcare provider network management, healthcare contracting, or a related field in the health insurance industry or healthcare provider industry.

Proven experience in leading contract negotiations with large healthcare providers.

Understanding of regulatory and accreditation requirements related to provider networks.

Personal Attributes / Skills

Leadership & Team Management

Negotiation & Communication

Analytical Skills

Problem-Solving

Project Management

Technology Proficiency

Others

Healthcare Network Management : Deep understanding of provider network dynamics, contract negotiations, and provider performance management.

Healthcare Systems & Insurance : Strong knowledge of healthcare systems, health insurance policies, claims processing, and regulatory requirements.

Contract Law : Understanding of contract law and healthcare regulations, especially as they pertain to healthcare provider agreements.

Financial Acumen : Strong understanding of financial principles in the healthcare industry, including cost containment, provider payment models, and ROI analysis.

Quality Assurance : Expertise in ensuring healthcare providers meet required quality standards and regulatory compliance.

Job Attributes

Seniority level : Mid-Senior level

Employment type : Full-time

Job function : Health Care Provider

Industries : Insurance

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