Verda Healthcare
Verda Health Plan of Arizona (Verda Healthcare, Inc.) is a state‑licensed health plan committed to ensuring that underserved communities have access to health and wellness services. We are looking for a Provider Network Manager to join our growing company.
Position Overview As a Provider Network Manager, you will build, maintain, and enhance strong relationships with Independent Physician Associations (IPAs), hospitals, and other contracted provider groups. Your responsibilities include communication, onboarding, issue resolution, and performance monitoring to ensure high-quality service for our contractual provider network. You will also serve as a key liaison between provider partners and internal Verda departments, driving collaboration to meet regulatory, operational, and strategic objectives.
Job Description
IPA & Hospital Relationship Management – Serve as primary relationship owner for assigned IPAs and hospital systems; conduct regular check‑ins and ensure contract compliance and performance.
Provider Onboarding & Communications – Coordinate onboarding for new IPAs and providers; ensure timely delivery of materials, orientation sessions, and operational readiness.
Provider Inquiries & Support – Serve as point of escalation for provider inquiries, resolving issues in collaboration with claims, utilization management, credentialing, and other internal teams.
IPA Roster Management – Receive, validate, and update incoming IPA rosters, ensuring provider data is accurate, current, and submitted on time to Provider Data Management (PDM) to meet CMS and compliance requirements.
Joint Operations Committees – Organize and facilitate quarterly IPA/hospital Joint Operations Committee meetings; drive consensus on performance priorities and follow‑up actions.
Internal Liaison – Collaborate with internal stakeholders (claims, UM, credentialing, compliance, member services, IT, and finance) to enforce contract terms and regulatory requirements, resolve provider issues and streamline processes.
Provider Events & Education – Plan, coordinate, and host provider meetings, trainings, and appreciation events to strengthen partnerships and improve engagement.
Network Adequacy Monitoring – Review monthly IPA network adequacy reports; work collaboratively with leadership to develop action plans for gaps in access and communicate network performance to IPAs.
Reporting – Develop and maintain reporting frameworks to track progress and strategic initiatives and network performance.
Growth and Development – Collaborate with Provider Network Operations leadership to identify growth opportunities, retention strategies, and outreach results.
Provider Adds/Terms – Manage and process provider additions and terminations, coordinating with credentialing, contracting, and directory maintenance teams.
Credentialing Support – Facilitate submission of provider credentialing applications, work with delegated Credentialing Verification Organization (CVO), and ensure adherence to NCQA/CMS standards.
Internal and External Communications – Support Provider Services communications by distributing policy updates, newsletters, and reminders.
Projects – Participate in projects and initiatives that enhance provider and member experiences.
Establish rapport and manage relationships with local PCP and specialist offices.
Perform other duties as assigned.
Requirements Minimum Qualifications
Bachelor’s degree in healthcare administration, business, or related field (or equivalent experience).
3–5 years of experience in provider relations, network management, or healthcare operations with a Medicare health plan, IPA, or hospital system.
Strong knowledge of managed care concepts, provider contracting, Medicare/MAPD, and healthcare delivery systems.
Experience with provider rosters, credentialing, and regulatory compliance (CMS, NCQA).
Proficiency with Microsoft Office Suite (Excel, PowerPoint, Word); ability to analyze data and prepare presentations.
Professional Competencies
Relationship Building – Develop and maintain trusted partnerships with IPAs, hospitals, and provider groups.
Communication Skills – Strong written and verbal communication, including presenting to large groups and facilitating meetings.
Problem‑Solving – Identify issues, analyze root causes, and collaborate on timely resolutions.
Organizational Agility – Navigate cross‑functional teams and balance provider needs with organizational priorities.
Attention to Detail – Ensure accuracy in roster management, reporting, and compliance‑driven processes.
Project Management – Plan, coordinate, and execute multiple provider initiatives simultaneously.
Customer Service Orientation – Commit to improving provider experience while supporting organizational objectives.
Job Type Full‑time
Benefits
401(k)
Paid time off (vacation, holiday, sick leave)
Health insurance
Dental insurance
Vision insurance
Life insurance
Schedule
Full‑time onsite (100% in‑office)
Hours of operations: 9am – 6pm; offsite meetings will vary.
Standard business hours Monday to Friday, occasional weekends as needed.
Occasional travel may be required for meetings and training sessions.
Ability to Commute / Relocate
Must reliably commute or plan to relocate before starting work (Required).
Physical Demands Regularly sit/walk at a workstation in an office or cubicle setting. Must occasionally lift and/or move up to 25–50 pounds. Other duties may be assigned in support of departmental goals.
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Position Overview As a Provider Network Manager, you will build, maintain, and enhance strong relationships with Independent Physician Associations (IPAs), hospitals, and other contracted provider groups. Your responsibilities include communication, onboarding, issue resolution, and performance monitoring to ensure high-quality service for our contractual provider network. You will also serve as a key liaison between provider partners and internal Verda departments, driving collaboration to meet regulatory, operational, and strategic objectives.
Job Description
IPA & Hospital Relationship Management – Serve as primary relationship owner for assigned IPAs and hospital systems; conduct regular check‑ins and ensure contract compliance and performance.
Provider Onboarding & Communications – Coordinate onboarding for new IPAs and providers; ensure timely delivery of materials, orientation sessions, and operational readiness.
Provider Inquiries & Support – Serve as point of escalation for provider inquiries, resolving issues in collaboration with claims, utilization management, credentialing, and other internal teams.
IPA Roster Management – Receive, validate, and update incoming IPA rosters, ensuring provider data is accurate, current, and submitted on time to Provider Data Management (PDM) to meet CMS and compliance requirements.
Joint Operations Committees – Organize and facilitate quarterly IPA/hospital Joint Operations Committee meetings; drive consensus on performance priorities and follow‑up actions.
Internal Liaison – Collaborate with internal stakeholders (claims, UM, credentialing, compliance, member services, IT, and finance) to enforce contract terms and regulatory requirements, resolve provider issues and streamline processes.
Provider Events & Education – Plan, coordinate, and host provider meetings, trainings, and appreciation events to strengthen partnerships and improve engagement.
Network Adequacy Monitoring – Review monthly IPA network adequacy reports; work collaboratively with leadership to develop action plans for gaps in access and communicate network performance to IPAs.
Reporting – Develop and maintain reporting frameworks to track progress and strategic initiatives and network performance.
Growth and Development – Collaborate with Provider Network Operations leadership to identify growth opportunities, retention strategies, and outreach results.
Provider Adds/Terms – Manage and process provider additions and terminations, coordinating with credentialing, contracting, and directory maintenance teams.
Credentialing Support – Facilitate submission of provider credentialing applications, work with delegated Credentialing Verification Organization (CVO), and ensure adherence to NCQA/CMS standards.
Internal and External Communications – Support Provider Services communications by distributing policy updates, newsletters, and reminders.
Projects – Participate in projects and initiatives that enhance provider and member experiences.
Establish rapport and manage relationships with local PCP and specialist offices.
Perform other duties as assigned.
Requirements Minimum Qualifications
Bachelor’s degree in healthcare administration, business, or related field (or equivalent experience).
3–5 years of experience in provider relations, network management, or healthcare operations with a Medicare health plan, IPA, or hospital system.
Strong knowledge of managed care concepts, provider contracting, Medicare/MAPD, and healthcare delivery systems.
Experience with provider rosters, credentialing, and regulatory compliance (CMS, NCQA).
Proficiency with Microsoft Office Suite (Excel, PowerPoint, Word); ability to analyze data and prepare presentations.
Professional Competencies
Relationship Building – Develop and maintain trusted partnerships with IPAs, hospitals, and provider groups.
Communication Skills – Strong written and verbal communication, including presenting to large groups and facilitating meetings.
Problem‑Solving – Identify issues, analyze root causes, and collaborate on timely resolutions.
Organizational Agility – Navigate cross‑functional teams and balance provider needs with organizational priorities.
Attention to Detail – Ensure accuracy in roster management, reporting, and compliance‑driven processes.
Project Management – Plan, coordinate, and execute multiple provider initiatives simultaneously.
Customer Service Orientation – Commit to improving provider experience while supporting organizational objectives.
Job Type Full‑time
Benefits
401(k)
Paid time off (vacation, holiday, sick leave)
Health insurance
Dental insurance
Vision insurance
Life insurance
Schedule
Full‑time onsite (100% in‑office)
Hours of operations: 9am – 6pm; offsite meetings will vary.
Standard business hours Monday to Friday, occasional weekends as needed.
Occasional travel may be required for meetings and training sessions.
Ability to Commute / Relocate
Must reliably commute or plan to relocate before starting work (Required).
Physical Demands Regularly sit/walk at a workstation in an office or cubicle setting. Must occasionally lift and/or move up to 25–50 pounds. Other duties may be assigned in support of departmental goals.
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