Network Program Specialist

Job Summary

Working remotely, the full-time Senior Network Program Specialist will manage provider networks, analyze performance data, and support the development of effective network programs while ensuring compliance with regulatory standards.

Key responsibilities:

• Analyze and validate network and provider performance data to inform program implementation and modifications
• Develop and drive effective network programs by determining performance metrics and collaborating with stakeholders
• Build and manage relationships with network program management stakeholders to enhance program performance and address issues

Required qualifications:

• Undergraduate degree or equivalent experience
• Understanding of demographic systems and claims platforms
• Knowledge of contracting strategies to support field objectives
• Familiarity with key provider performance indicators and risk adjustment metrics
• Understanding of applicable health care regulations and documentation procedures