Group 1001
Join to apply for the
Manager, Provider Network - Medicare
role at
Group 1001 , a consumer‑centric, technology‑driven family of insurance companies dedicated to delivering outstanding value, operational performance, and deep insurance expertise. This role focuses on building, managing, and growing a Medicare Advantage provider network across multiple states.
Company Overview
Clear Spring Health, part of Group 1001, provides Medicare Advantage and Prescription Drug Plans in selected counties across Colorado, Illinois, North Carolina, Virginia, Georgia, and South Carolina, plus 42 states plus DC. The mission is to simplify health to enrich lives through clarity, compassion, and connection.
Why This Role Matters
The Manager will oversee contracting, provider relations, and performance of the Medicare Advantage provider network, ensuring network adequacy, provider satisfaction, and operational integrity meet CMS requirements and organizational standards.
How You'll Contribute Network Development & Contracting
Oversee the recruitment, contracting, and onboarding of providers across all specialties to ensure network adequacy.
Negotiate provider agreements, fee schedules, and amendments in alignment with company policy and CMS regulations.
Coordinate with the TPA to maintain accurate provider data in compliance with directory accuracy standards.
Provider Relationship Management
Build and maintain strong, collaborative relationships with providers, health systems, and delegated entities.
Oversee day‑to‑day provider relations functions including onboarding, engagement, and issue resolution.
Serve as an escalation point for complex provider issues, ensuring timely resolution.
Monitor provider satisfaction and implement initiatives to improve the provider experience.
Regulatory & Compliance Oversight
Ensure all contracting and credentialing activities adhere to CMS, state, and NCQA standards.
Partner with Compliance and Credentialing teams to support pre‑delegation audits, FDR attestations, and network adequacy submissions.
Support CMS reporting and readiness activities, including provider directory validation and access‑to‑care analyses.
Performance & Operations
Coordinate with the TPA to ensure proper and timely provider credentialing and loading.
Lead a team responsible for provider issue resolution.
Track and report key performance indicators such as network adequacy and provider satisfaction.
Collaborate with TPA Claims, Configuration, and Credentialing to ensure end‑to‑end network accuracy and performance.
Leadership & Collaboration
Coach and develop staff, fostering a culture of accountability, collaboration, and continuous improvement.
Contribute to annual strategic planning, budget development, and process‑improvement initiatives.
Represent Network Management in internal committees and external stakeholder meetings.
What We’re Looking For
Bachelor’s degree in Healthcare Administration, Business, or related field required; Master’s degree preferred.
Minimum 5–7 years in provider network management or contracting within a Medicare Advantage or managed care environment.
Demonstrated understanding of CMS requirements, risk‑based contracting, and provider reimbursement methodologies (FFS, capitation, value‑based).
Experience leading teams and managing cross‑functional projects.
Excellent analytical, organizational, and communication abilities.
Proficient in Microsoft Office and provider network management tools (e.g., FACETS, HealthEdge).
Strong negotiation and relationship‑management skills.
Compensation Base pay ranges from $100,000/year in the lowest geographic market to $135,000/year in the highest market, based on location, experience, and other factors.
Benefits Highlights Eligible employees receive comprehensive health, dental, and vision insurance; life insurance; short and long‑term disability; Employee Assistance Program; wellness programs; 401(k) plan with matching contributions; and more.
Group 1001 is strongly committed to a supportive work environment where employee differences are valued. Diversity is essential for building a high‑performance team.
#J-18808-Ljbffr
Manager, Provider Network - Medicare
role at
Group 1001 , a consumer‑centric, technology‑driven family of insurance companies dedicated to delivering outstanding value, operational performance, and deep insurance expertise. This role focuses on building, managing, and growing a Medicare Advantage provider network across multiple states.
Company Overview
Clear Spring Health, part of Group 1001, provides Medicare Advantage and Prescription Drug Plans in selected counties across Colorado, Illinois, North Carolina, Virginia, Georgia, and South Carolina, plus 42 states plus DC. The mission is to simplify health to enrich lives through clarity, compassion, and connection.
Why This Role Matters
The Manager will oversee contracting, provider relations, and performance of the Medicare Advantage provider network, ensuring network adequacy, provider satisfaction, and operational integrity meet CMS requirements and organizational standards.
How You'll Contribute Network Development & Contracting
Oversee the recruitment, contracting, and onboarding of providers across all specialties to ensure network adequacy.
Negotiate provider agreements, fee schedules, and amendments in alignment with company policy and CMS regulations.
Coordinate with the TPA to maintain accurate provider data in compliance with directory accuracy standards.
Provider Relationship Management
Build and maintain strong, collaborative relationships with providers, health systems, and delegated entities.
Oversee day‑to‑day provider relations functions including onboarding, engagement, and issue resolution.
Serve as an escalation point for complex provider issues, ensuring timely resolution.
Monitor provider satisfaction and implement initiatives to improve the provider experience.
Regulatory & Compliance Oversight
Ensure all contracting and credentialing activities adhere to CMS, state, and NCQA standards.
Partner with Compliance and Credentialing teams to support pre‑delegation audits, FDR attestations, and network adequacy submissions.
Support CMS reporting and readiness activities, including provider directory validation and access‑to‑care analyses.
Performance & Operations
Coordinate with the TPA to ensure proper and timely provider credentialing and loading.
Lead a team responsible for provider issue resolution.
Track and report key performance indicators such as network adequacy and provider satisfaction.
Collaborate with TPA Claims, Configuration, and Credentialing to ensure end‑to‑end network accuracy and performance.
Leadership & Collaboration
Coach and develop staff, fostering a culture of accountability, collaboration, and continuous improvement.
Contribute to annual strategic planning, budget development, and process‑improvement initiatives.
Represent Network Management in internal committees and external stakeholder meetings.
What We’re Looking For
Bachelor’s degree in Healthcare Administration, Business, or related field required; Master’s degree preferred.
Minimum 5–7 years in provider network management or contracting within a Medicare Advantage or managed care environment.
Demonstrated understanding of CMS requirements, risk‑based contracting, and provider reimbursement methodologies (FFS, capitation, value‑based).
Experience leading teams and managing cross‑functional projects.
Excellent analytical, organizational, and communication abilities.
Proficient in Microsoft Office and provider network management tools (e.g., FACETS, HealthEdge).
Strong negotiation and relationship‑management skills.
Compensation Base pay ranges from $100,000/year in the lowest geographic market to $135,000/year in the highest market, based on location, experience, and other factors.
Benefits Highlights Eligible employees receive comprehensive health, dental, and vision insurance; life insurance; short and long‑term disability; Employee Assistance Program; wellness programs; 401(k) plan with matching contributions; and more.
Group 1001 is strongly committed to a supportive work environment where employee differences are valued. Diversity is essential for building a high‑performance team.
#J-18808-Ljbffr