Provider Network Specialist jobs in Hamilton, OH

Description

Curana Health is a provider of value-based primary care services exclusively for the senior living industry, including in nursing homes, assisted/independent living facilities, CCRC/life plan communities and affordable senior housing communities. Curana Health serves more than 1,100 senior living community partners across 30 states and participates in both the MSSP ACO, ACO Reach and Medicare Advantage programs with CMS. Backed by more than $300M in venture capital funding, the organization is poised to disrupt care delivery in senior living on a meaningful scale through innovative care models and applied analytics.

**Position is remote, but must be located in the state of OH**

ESSENTIAL DUTIES AND RESPONSIBILITIES

1. Provider Network Management: Overseeing the development, maintenance, and expansion of the provider network. This involves identifying potential providers, negotiating contracts, and maintaining strong relationships with existing providers.
2. Contract Negotiation: Leading contract negotiations with healthcare providers to ensure favorable terms for both the organization and the providers. This includes fee schedules, reimbursement rates, and service level agreements.
3. Network Strategy: Developing and implementing strategic plans to optimize the provider network, meet organizational goals, and enhance the quality of care provided to members.
4. Performance Monitoring: Monitoring provider performance metrics such as network utilization, cost efficiencies, and member satisfaction. Implementing improvements where necessary.
5. Compliance: Ensuring that all provider contracts and relationships comply with regulatory requirements and organizational policies.
6. Collaboration: Collaborating with internal teams such as finance, operations, and quality management to align provider network strategies with overall business objectives.
7. Issue Resolution: Addressing and resolving any provider-related issues, disputes, or concerns in a timely and effective manner to maintain positive provider relationships.
8. Data Analysis: Utilizing data analytics and reporting tools to track and analyze provider network performance, identify trends, and make data-driven decisions.
9. Stakeholder Communication: Communicating with stakeholders, including providers, internal teams, and leadership, to ensure alignment on network strategies and performance goals.
10. Stay Informed: Staying informed about industry trends, regulatory changes, and best practices in provider network management to continuously improve operations and outcomes.

Qualifications

• Education: Bachelor's degree in Business Administration, Healthcare Management, or a related field. A Master's degree is preferred.
• Experience: 4 – 8 years of experience in negotiating and servicing managed care contracts with physician, hospital, and/or other provider contracts.
• Ability and willingness to travel up to 30% of the time
• Skills and Competencies:
  • Strong negotiation and communication skills.
  • Deep understanding of healthcare regulations and compliance requirements.
  • Ability to build and maintain relationships with diverse stakeholders.
  • Analytical skills with the ability to interpret complex data.
  • Excellent project management and organizational skills.

Curana Health is dedicated to the principles of Equal Employment Opportunity. We affirm, in policy and practice, our commitment to diversity. We do not discriminate on the basis of actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth and related medical conditions), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable or state law, genetic information, or any other characteristic protected by applicable federal, state and local laws and ordinances.   

The EEO policy applies to all personnel matters as outlined in our company policy including recruitment, hiring, transfers, and general treatment during employment. 

Qualifications