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Provider Network Manager, Medicaid Services

Hello Itsme
Woburn, MA Full Time
POSTED ON 1/19/2025
AVAILABLE BEFORE 4/19/2025

Provider Network Manager, Medicaid Services

Job Title : Provider Network Manager, Medicaid Services

Read on to fully understand what this job requires in terms of skills and experience If you are a good match, make an application.

About Hello, It's Me

Hello, It's Me (https : / / hello-itsme.com) is an innovative healthcare technology platform transforming support services for individuals with intellectual and developmental disabilities (IDD). We partner with state Medicaid programs to deliver comprehensive, technology-enabled support services that enhance independence and community participation for individuals with IDD.

Position Overview

We're seeking an experienced Provider Network Manager to lead our Missouri market expansion, focusing on provider enablement, network development, and Medicaid program integration. This role will be instrumental in building and managing relationships with key stakeholders across Missouri's IDD provider ecosystem while ensuring the successful implementation of our innovative support service platform.

Core Responsibilities

  • Develop and execute provider network strategy for Missouri market expansion
  • Lead provider recruitment, contracting, and onboarding initiatives
  • Navigate Missouri DMH requirements and Medicaid regulations
  • Manage relationships with key stakeholders including :

IDD service providers

  • County boards
  • State Medicaid officials
  • Regional provider associations
  • Ensure provider network compliance with state requirements
  • Drive provider adoption and utilization of platform services
  • Monitor network adequacy and performance metrics
  • Develop and deliver provider education programs
  • Collaborate with internal teams on provider enablement strategies
  • Required Qualifications

  • Bachelor's degree in Healthcare Administration, Business, or related field
  • 2 years of experience in provider network management, preferably in Medicaid / LTSS
  • Demonstrated knowledge of Missouri Medicaid and IDD service system
  • Experience with provider contracting and relationship management
  • Understanding of HCBS Waiver programs and requirements
  • Proven track record in healthcare provider engagement
  • Proficiency in network adequacy analysis and reporting
  • Valid driver's license with ability to travel throughout Missouri
  • Preferred Qualifications

  • Experience with digital health or healthcare technology implementation
  • Background in IDD service delivery or support coordination
  • Knowledge of Missouri DMH policies and procedures
  • Familiarity with person-centered planning principles
  • Experience with value-based contracting models
  • Provider credentialing experience
  • Provider relationship management
  • Contract negotiation and administration
  • Network development strategy
  • Regulatory compliance
  • Provider education and training
  • Data analysis and reporting
  • Project management
  • Problem-solving
  • Communication and presentation
  • Key Performance Areas

  • Provider network development and growth
  • Network adequacy maintenance
  • Provider satisfaction and retention
  • Compliance with state requirements
  • Implementation timeline adherence
  • Quality metrics achievement
  • Travel Requirements

  • 70% to 80% travel within Missouri
  • Occasional out-of-state travel for conferences and training
  • Hybrid work arrangement with regular field visits
  • Join a mission-driven organization transforming IDD support services through innovative technology while leveraging your provider network expertise to create meaningful change in healthcare delivery.

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