What are the responsibilities and job description for the Network Account Manager, SCO and OneCare position at C3?
Title: Network Account Manager, SCO and OneCare
Reports to: Sr. Director of Provider Network, SCO and OneCare
Classification: Individual Contributor
Location: Boston, MA (Hybrid)
Job description revision number and date: V2.0; 3/31/2025
Organization Summary:
Community Care Cooperative (C3) is a 501(c)(3) non-profit, Accountable Care Organization (ACO) governed by Federally Qualified Health Centers (FQHCs). Our mission is to leverage the collective strengths of FQHCs to improve the health and wellness of the people we serve. We are a fast-growing organization founded in 2016 with 9 health centers and now serving hundreds of thousands of beneficiaries who receive primary care at health centers and independent practices nationally. We are an innovative organization developing new partnerships and programs to improve the health of members and communities, and to strengthen our health center partners.
SCO and One Care Summary
The Senior Care Options (SCO) and One Care programs are health plan programs for dually eligible (Medicare and Medicaid) individuals (“duals”) in Massachusetts. SCO serves eligible beneficiaries aged 65 , while One Care serves duals between ages 21-64. These programs are Fully Integrated Dual-Eligible Special Needs Plans (FIDE-SNP) that integrate Medicare and Medicaid benefits, along with additional supports for enrollees such as integrated care teams, care managers, social supports, etc.
Massachusetts’ Medicaid (MassHealth) agency recently conducted a procurement for health plans to offer products in these two programs, for a five-year term starting January 1, 2026. C3 submitted a bid and was selected in September 2024.
Job Summary:
Under the direction of the Sr. Director of Provider Network, the Network Account Manager is an individual contributor role responsible for supporting provider network development and fostering strong relationships with healthcare providers. This role will ensure efficient contract negotiations and execution, provider engagement, and issue resolution to enhance network performance and provider satisfaction.
Responsibilities:
- Assist in the contracting process for new and existing providers, ensuring compliance with health plan policies and regulatory requirements
- Support network development efforts by identifying and engaging potential providers to enhance access and coverage
- Serve as a liaison between the health plan and providers, addressing concerns, facilitating resolutions, and escalating issues as necessary
- Develop provider materials and trainings, including educational materials, payment policies, webinars, and other
- Provide training and education to providers on contract terms, billing procedures, and operational processes to ensure compliance and efficiency
- Monitor provider performance and satisfaction, working proactively to mitigate challenges and optimize network relationships
- Collaborate with internal teams, including credentialing, claims, and member services, to support seamless provider operations and ensure provider performance
- Track and report on provider engagement activities, issue trends, and resolution outcomes to support leadership decision-making
- Ensure compliance with state, CMS, NCQA, and other applicable regulations
- Ensure reporting requirements are met and support all necessary provider network analysis
- Other responsibilities as assigned
Required Skills:
- Experience in healthcare provider contracting, network management, or provider relations within a Medicaid, Medicare, or commercial health plan
- Strong relationship management and communication skills, with the ability to engage and educate providers effectively
- Knowledge of healthcare regulations, reimbursement methodologies, and managed care principles
- Problem-solving and issue-resolution abilities with a proactive, solution-oriented approach
- Meticulous orientation to details and ability to handle multiple concurrent assignments
- Excellent written and oral communications including the ability to present complex situations in a clear and concise manner
- Ability to work independently, and as part of a team, while aligning with strategic goals set by leadership
- Experience working in a fast-paced environment
- Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint, etc.)
- Collaborative, flexible, innovative
Desired Other Skills:
- Familiarity with SCO/OneCare
- Familiarity with provider data and analytics software
- Experience with anti-racism activities, and/or lived experience with racism is highly preferred
Qualifications:
- 3 years of healthcare provider contracting or provider relations required
- Prior health plan experience
** In compliance with Covid-19 Infection Control practices per Mass.gov recommendations, we require all employees to be vaccinated consistent with applicable law. **
