Medicare Network Manager

What Will Your Job Look Like?

The Medicare Network Manager will primarily be responsible for the development and maintenance of specialized networks to meet the needs of Medicare Advantage populations. The Medicare Network Manager will own the delivery of a high level of service to our vendors every day, ensuring high operational standards and vendor satisfaction within an assigned geographic area. The Medicare Network Manager would manage the day-to-day interaction with the vendors, acting as an Account Manager to build and sustain strong working relationships with cross functional departments and assigned Providers.

This role is key to the success of a successful relationship with our Transportation Providers.

If you reside within 40miles or an MTM office this will be a Hybrid role. If you reside outside of that 40miles this role is fully remote.

• Work with the Transportation Provider (TP) to follow through on service issues, troubleshooting problems and concerns, complaints, and education
• Utilize data to develop and deliver performance improvement plans (PIP)
• Coordinate and conduct monthly provider performance evaluations
• Conduct off boarding for providers not meeting standard expectations
• Serve as the first point of contact for all vendor service requests and escalations
• Own the day-to-day vendor interaction and satisfaction
• Conduct on site vehicle inspections and provider audits to verify compliance with MTM and HIPAA guidelines
• Deliver timely, accurate and professional operational support to all vendors within a specified geographic area and Service Level Agreements
• Demonstrate proactive leadership by working with internal MTM teams and external client teams, when necessary, to ensure complete resolution of TP issues
• Demonstrate proficiency by providing effective consultation to TP’s and guidance to internal team members
• Utilize Salesforce as the single source of truth for managing vendor interactions and credentialing compliance
• Recognize opportunities to educate TP’s contacts on MTM processes when necessary
• Build and sustain a strong working partnership with assigned transportation providers
• Assist with/participate/facilitate regular provider town hall meetings
• Handle inbound service requests and ensure that they are properly assigned or addressed
• Liaise with other internal departments as required to resolve vendor’s issues and questions
• Provide ongoing support to transportation providers regarding claims, payments, eligibility, utilization management or any other questions impacting provider performance
• Meet or exceed assigned KPI’s and business objectives
• Meet all provider compliance requirements, including but not limited to inspections, audits and credentialing, ensuring non-compliant Vendors are not performing services for MTM
• Submit provider configuration changes to data management team and partner with them to ensure vendor is set up properly in the systems

• High School diploma or GED
• College Degree or Equivalent Work Experience
• 2-5 years’ experience as an Account Manager
• 2 years’ operational experience
• Must possess a valid driver’s license
• Must be able to conduct inspections, audits, communicate issues, and corrective actions from an authoritative position but with professional courtesy

• Demonstrate excellent time management skills
• Knowledge of transportation logistics, patient experience, and managed care
• Ability to maintain positive and team focused during high stress situations
• Persuasive negotiator
• Strong ability to pay attention to detail
• Excellent communication skills
• Ability to maintain high level of confidentiality
• Must be able to communicate with staff of all job levels professionally
• Ability to prioritize assigned projects, incidents, and requests
• Ability to identify with customers' needs and circumstances
• Ability to recognize, handle and refer situations of an emergent nature

• Experience in Project Management and/or Contract Negotiations is preferred
• Experience in Cost Management is preferred

• Health and Life Insurance Plans
• Dental and Vision Plans
• 401(k) with a company match
• Paid Time Off and Holiday Pay
• Maternity/Paterni…