Provider Network Manager

Job Description must be located in Connecticut.

A bit about this role:
It is a key position in our organization that requires a strong understanding of Medicare Advantage quality programs, including CMS STAR measures, and the ability to collaborate with providers to identify and close clinical care gaps, improve quality performance, and support initiatives that enhance member outcomes and overall plan performance.

This role will also be responsible for network development and management, as well as servicing an assigned geographic area. The ideal candidate will possess 5+ years of experience recruiting and managing provider networks, negotiating, reviewing, and amending contracts, and will have thorough knowledge of contracting with physicians, physician groups, integrated delivery systems, health systems, and ancillary providers using various payment methodologies such as fee‑for‑service and value‑based/risk.

An important competency is a high level of business acumen that can be exhibited both internally and externally to a wide variety of audiences. Innovation, independence, and confidence are key competencies that need to be demonstrated.

• Develop, maintain, and manage an adequate provider network in the assigned geographic area.
• Maintain relationships and all provider relations activities, including negotiating and renegotiating contracts with providers.
• Engage internal subject matter experts and providers to identify opportunities to improve provider/member cost and quality performance.
• Monitor various reports to ensure all necessary compliance requirements are met and maintained.
• Report to leadership the current status, risks, and potential opportunities in the area of responsibility on a regular basis.
• Support the overall Network Team to achieve success for Devoted Health.
• Support assigned groups to improve performance in CMS STAR measures, educate providers and their staff on STAR measure requirements, identify performance gaps through data analysis, coordinate with internal quality teams to implement improvement initiatives, review provider‑level performance reports, and work directly with practices to implement workflows and best practices that improve quality outcomes, member satisfaction, preventive care compliance, and clinical documentation accuracy.
• Utilize performance dashboards and reporting tools to track STAR measure performance, HEDIS metrics, and other quality indicators, proactively engage providers whose performance falls below targets, and collaborate on action plans to improve results.
• Partner with internal quality, clinical, and analytics teams to interpret STAR performance reports and translate insights into actionable strategies for providers, ensuring alignment with organizational goals and CMS quality improvement priorities.

• 5+ years of negotiating provider contracts, including physician/provider group contracts, with multiple payment methodologies such as value‑based/risk.
• Provider servicing experience.
• Solid ability to navigate either Google or MS Suite of products.
• High School Diploma or equivalent.
• Experience in CMS STAR measures.
• Experience and relationships in the local market.
• Unrestricted driver’s license to verify eligibility and capability to fulfill the driving responsibilities associated with the position.

• Ability to make quick, independent decisions.
• Mutually beneficial negotiation skills.
• Strong project management skills.
• Attention to detail.
• Ability to analyze financial and performance reports and identify trends/variances.
• Big picture thinking and understanding of how decisions impact the network as a whole.
• Extremely effective oral and written communication skills.

$80,000–$100,000 per year.

• Employer‑sponsored health, dental, and vision plan with low or no premium.
• Generous paid time off.
• $100 monthly mobile or internet stipend.
• Stock options for all employees.
• Bonus eligibility for all roles excluding Director and above; commission eligibility for Sales roles.
• Parental leave program.
• 401(k) program.
• Additional benefits available as part of the total rewards package.