Overview
We are seeking a dynamic and strategic leader to serve as the Director of Network Management for our PACE (Program of All-Inclusive Care for the Elderly) facility.This person will oversee the development, contracting, credentialing, and management of a high-performing provider network for the assigned geographic area. This individual ensures network adequacy, compliance with CMS and state-specific PACE regulations, and strong relationships with community-based providers, specialists, hospitals, and ancillary services to support the holistic care needs of PACE participants.
Duties
- Implements provider network strategies to ensure access to comprehensive, high-quality care and services for PACE participants. Must have experience building a network for Florida PACE/CMS.
- Overseas all providers and vendor contracting activities, including hospitals, specialists, behavioral health providers, transportation, home health, and long-term care facilities.
- Negotiates and manages contracts in collaboration with the Finance Team with a focus on value-based outcomes, care coordination, and cost-efficiency.
- Ensures contracts align with CMS PACE requirements and state regulatory standards.
- Directs the credentialing and recredentialing process for all network providers in compliance with CMS and State standards.
- Ensures timely provider onboarding to support care delivery and participant needs.
- Monitors credentialing systems and implement continuous process improvements.
- Manages and evaluates third-party vendors supporting network functions, including credentialing, transportation, and ancillary services.
- Builds and maintain collaborative relationships with network providers and community partners to support participants.
- In collaboration with Program Directors, resolve provider concerns and issues, promoting a culture of accountability, respect, and continuous improvement.
- Develop and lead provider education, communications, and engagement initiatives.
- Partners with internal departments such as Strategy, Program Directors, Compliance, Finance, and Quality to align network activities with organizational goals.
- Develop and manage KPIs and dashboards to track provider performance, network adequacy, and participant satisfaction.
- Identifies and addresses network gaps in coordination with clinical and operational leadership, ensuring alignment with regulatory access requirements.
- Supports program growth and expansion into new service areas through targeted provider recruitment and partnerships.
Skills
- Bachelor’s degree in health administration, Public Health, Business, or related field required, master’s degree preferred.
- 5+ years of progressive leadership experience in network management, preferably in managed care or integrated care delivery settings.
- Experience in a PACE program, Medicare Advantage, Medicaid managed care, or senior care environment strongly preferred.
- Proven track record of successful provider network development, contracting, and vendor oversight in a highly regulated setting.
- Extensive experience in medical management within complex healthcare settings, with senior or elderly populations
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Experience:
- PACE/CMS: 1 year (Required)
Location:
Ability to Commute:
Willingness to travel:
Work Location: Remote
