Network Management Implementation Specialist

• Coordinate end-to-end provider onboarding and offboarding management:
  Project manage all cross-functional tasks and deliverables associated with the provider onboarding, including pre-delegation audits, roster loading and display, MFT setup, claims payment configuration, and reporting activation to ensure seamless onboarding experiences.
• Manage provider offboarding processes:
  Ensure smooth offboarding when a provider terminates or changes MSO affiliation by coordinating member reassignment, provider data removal, report deactivation, and compliant member communication in partnership with internal teams.
• Develop and maintain workflows and documentation:
  Design, implement, and regularly update standardized workflows, procedures, and timelines to support consistent practices, operational readiness, and data integrity throughout the full provider lifecycle.
• Ensure clear operational handoffs across departments and adherence to established timelines for onboarding and offboarding activities.
• Collaborate with Network Training and Compliance teams:
  Partner with the Network Training Specialist for all education and training needs, and work with the Compliance team to confirm all policies, desktop procedures, and materials associated to provider onboarding and offboarding comply with regulatory and organizational standards.
• Monitor project milestones and risk management:
  Track and analyze project deliverables, identify risks or process gaps, and coordinate timely resolutions with business partners to maintain accuracy and efficiency across operational readiness for provider onboarding and offboarding.
• Serve as subject matter expert and liaison:
  Represent Network Management in cross-functional meetings and governance committees related to provider onboarding and offboarding, providing insight and expertise on provider implementation, configuration readiness, and operational optimization.
• Ensure regulatory and audit readiness:
  Promote compliance and adherence to CMS, DMHC, DHCS, and NCQA requirements through accurate documentation, lifecycle tracking, and post-termination data closure activities to maintain audit preparedness and meet quality standards.
• Facilitate provider communications, education, and presentations:
  Collaborate with Network Training and Communications teams to enhance provider onboarding materials, orientation tools, and outreach initiatives enhancing provider understanding and engagement.
• Conduct provider presentations and engage directly with provider partners to ensure clarity around onboarding expectations, operational workflows, and ongoing requirements.
• Drive continuous process improvement:
  Identify and implement enhancements to workflows, tools, templates, and reporting processes that increase efficiency, accuracy, and provider satisfaction throughout the lifecycle.
• Support system modernization and integration efforts:
  Contribute to SCAN’s system improvement and migration projects by capturing business requirements, testing enhancements, validating changes, and supporting implementation during and after release.

• 3-5 years' experience in provider network management, healthcare operations, or implementation roles requiring cross-functional collaboration, process coordination, and strong communication skills.
• At least 3 years’ experience in provider onboarding and direct provider engagement, including delivering presentations and facilitating discussions on operational workflows, onboarding expectations, and compliance requirements.
• Must demonstrate a solid understanding of Medicare Advantage operations and provider-facing processes.
• Bachelor's Degree or equivalent experience required.
• Graduate or Advanced Degree or equivalent experience preferred.
• Skilled in Microsoft Office (Word, Excel, Outlook, Teams, PowerPoint, Visio).

Demonstrates expertise in provider onboarding and offboarding management, ensuring compliance with regulatory standards while enhancing operational workflows and communication strategies. Proficient in project management and process improvement to drive efficiency and provider satisfaction throughout the provider lifecycle.

• Provider Onboarding Management
• Healthcare Operations
• Medicare Advantage Operations
• Cross-Functional Collaboration
• Process Improvement

• Provider Network Management
• Project Management
• Workflow Development
• Data Integrity
• Risk Management

• Strong Communication Skills
• Collaboration
• Facilitation
• Presentation Skills

• CMS Compliance
• DMHC
• DHCS
• NCQA
• Operational Readiness

• Microsoft Office
• Visio