Account Manager, Hospital Relations; Health Plans

Overview

VNS Health is seeking an experienced

Account Manager – Hospital & Ancillary Relations to serve as a key liaison between VNS Health Plans and our hospital, health system, and ancillary provider partners. In this role, you will manage an assigned portfolio of complex provider relationships, supporting hospitals and ancillary providers in navigating health plan operations, resolving issues, and strengthening overall provider engagement and partnership.

The Account Manager will work closely with hospital systems and a diverse range of ancillary providers, including laboratory and radiology, and other specialty providers. This role requires a strong understanding of managed care operations and the ability to coordinate across internal teams to address provider concerns and drive issues through resolution.

This is an ideal opportunity for someone with health plan, hospital, health system, or ancillary provider experience who enjoys building strong provider relationships, understands healthcare operations, and knows how to bring the right stakeholders together to solve complex problems.

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 20 days of paid time off and 9 company holidays
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
• Employer-matched 401k retirement saving program
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care and commuter transit program
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement and CEU credits

• Manage an assigned portfolio of hospital, health system, and ancillary provider relationships, serving as a primary point of contact for provider leadership and key operational stakeholders.
• Build and maintain strong, collaborative provider relationships through regular meetings, business reviews, site visits, provider education, and ongoing communication.
• Support hospitals and ancillary providers in navigating VNS Health Plans' operational processes, requirements, programs, and initiatives.
• Coordinate the resolution of complex provider issues involving claims, billing, payment, configuration, credentialing, contracting, utilization management, quality, compliance, authorizations, provider data, and member services, partnering with the appropriate internal teams.
• Serve as a liaison between providers and internal VNS Health departments to ensure issues are appropriately escalated, tracked, communicated, and resolved.
• Educate hospital and ancillary provider partners on VNS Health Plans policies, procedures, operational requirements, Medicare and Medicaid programs, regulatory requirements, and new initiatives.
• Support the implementation and ongoing administration of provider agreements in partnership with Contracting, Network, Provider Data, Operations, Claims, Quality, Utilization Management, and other applicable teams.
• Review provider performance, operational, and utilization data to identify trends, discrepancies, risks, service issues, and opportunities for improvement.
• Identify recurring or systemic provider issues and collaborate with internal stakeholders to support sustainable solutions and process improvements.
• Conduct or support hospital and ancillary provider meetings, operational reviews, and site visits, ensuring provider concerns, action items, and commitments are documented and followed through.
• Support provider onboarding, operational readiness, new program implementations, and changes impacting hospital and ancillary provider partners.
• upport regulatory and internal audits, provider corrective actions, compliance activities, and other health plan initiatives as appropriate.
• Maintain accurate documentation of provider interactions, issues, escalations, commitments, and follow-up activities in the appropriate systems.
• Lead or participate in special projects and cross-functional initiatives impacting hospitals, health systems, ancillary providers, and the broader provider network.

• Experience in Hospital Relations, Provider Relations, Network Management, Provider Services, Hospital Operations, Health Plan Operations, or Ancillary Provider Management.
• Experience working directly with hospitals, health systems, ancillary providers, or other complex healthcare organizations.
• Strong understanding of managed care and healthcare operations, including provider servicing and…