Manager – Network Development

Job Details

The Manager, Network Development is responsible for building and maintaining a robust, competitive, compliant, and accessible provider network across current and expansion service areas. This role oversees a team of network development specialists and works collaboratively to ensure the provider network meets Pennsylvania DHS, PID, CMS and other applicable regulatory adequacy requirements, while also supporting strategic growth and provider satisfaction.

Job Description

Essential Functions

• Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.
• Develop and implement network expansion strategies aligned with access standards and regional adequacy goals, including time-and-distance and provider-to-member ratio metrics
• Monitor and report on network adequacy and provider participation to meet regulatory submission timelines.
• Lead and manage a team of network development staff to execute contracting and network development initiatives throughout the current servicing area, and future expansion areas.
• Negotiate provider agreements with independent physicians, and other ancillary partners to support Medicaid, CHIP, Medicare, Exchange and other lines of business.
• Partner with Credentialing, Provider Relations, Compliance, Analytics and other internal areas to streamline provider onboarding and ensure accurate, up-to-date provider data for state submissions.
• Collaborate with internal stakeholders to support growth strategies and expansion.
• Support annual readiness reviews, corrective action plans (CAPs), audits, and RFP-related network development tasks.
• Foster strong provider relationships that support collaborative care, reduce abrasion, and promote value-based care initiatives where applicable.
• Perform other duties as assigned.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Competencies (Knowledge, Skills, and Abilities Required):

• Deep understanding of Pennsylvania’s Medicaid, Medicare and/or Exchange requirements and provider landscape.
• Proven track record of successful provider negotiations, network adequacy analysis, and regulatory compliance.
• Strong organizational, interpersonal, and communication skills.
• Proficiency in provider database systems, Microsoft Office Suite, and regulatory reporting platforms.
• Familiarity with value-based care or alternative payment models within Medicaid preferred.

Minimum Education and Experience Requirements:

Education:

• Bachelor's degree required; master’s in healthcare administration, public health, or related field preferred.

AND

Experience:

• Minimum 5-7 years of experience in provider contracting, network development, or managed care.
• At least 2 years of supervisory or team lead experience, with demonstrated ability to coach and manage staff.

Additional Information

Please note this job description is not designed to cover or contain a comprehensive listing of

activities, duties, or responsibilities that are required of the employee for their job. Duties,

responsibilities, and activities may change at any time with or without notice.

Compliance Statement:  Compliance with all applicable rules, regulations and laws is a condition of employment.  Employees must read and sign the Code of Conduct and be expected to perform their duties ethically and honestly.

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Health Partners Plans, Inc.

Primary Location Address

1101 Market, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.    

Jefferson is committed to providing equal educa­tional and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status. 

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

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