Non-Emergency Medical Transportation (NEMT) Provider Network Manager
Position Summary
The Non-Emergency Medical Transportation (NEMT) Provider Network Manager is responsible for the development, management, compliance, and performance oversight of the transportation provider network supporting Medicaid, Medicare Advantage, Managed Care, and other healthcare transportation programs. This role ensures network adequacy, provider credentialing compliance, operational performance, quality assurance, contract management, and strong provider relationships to support safe, reliable, and cost-effective transportation services.
The Provider Network Manager collaborates cross-functionally with operations, quality assurance, compliance, claims, dispatch, customer service, and executive leadership to maintain a high-performing transportation network aligned with federal, state, contractual, and organizational standards. The role also supports ongoing provider recruitment, education, auditing, and performance improvement initiatives.
This position supports adherence to industry operational standards including NEMT provider compliance, safety, credentialing, HIPAA, ADA accessibility, and fraud prevention requirements.
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Essential Duties & Responsibilities
Network Development & Management
· Recruit, onboard, and maintain an adequate network of qualified transportation providers.
· Ensure network coverage meets geographic and contractual access standards.
· Develop and maintain strong provider relationships through regular communication and engagement.
· Negotiate provider contracts, reimbursement structures, and service expectations.
· Monitor provider participation, retention, and performance trends.
· Maintain accurate provider records, credentialing documentation, and contract files.
Provider Credentialing & Compliance
· Oversee provider credentialing and recredentialing processes.
· Verify compliance with:
o State licensing requirements
o Insurance requirements
o Driver background checks
o OIG/OFAC exclusion screenings
o Vehicle inspections and maintenance records
o ADA and wheelchair accessibility standards
o HIPAA privacy and security requirements
· Monitor provider adherence to company policies, Medicaid regulations, and contractual obligations.
· Coordinate corrective action plans for non-compliant providers.
Industry guidance recommends oversight of driver hiring criteria, onboarding, training, insurance, fleet maintenance, compliance policies, and operational safety standards.
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Operational Performance Oversight
· Monitor provider operational metrics including:
o On-time performance (OTP)
o Trip completion rates
o Ride acceptance rates
o Complaint rates
o Escalation response times
· Analyze provider scorecards and implement performance improvement initiatives.
· Conduct provider audits, field visits, and operational reviews.
· Collaborate with dispatch and operations teams to resolve service gaps and escalated issues.
· Ensure providers meet service level agreements (SLAs) and quality expectations.
Example operational targets may include:
· Network Adequacy ≥ 95%
· On-Time Performance ≥ 90%
· Trip Completion Rate ≥ 98%
· Ride Acceptance Rate ≥ 85%
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Quality Assurance & Regulatory Oversight
· Support quality assurance audits and post-payment verification processes.
· Investigate complaints, grievances, incidents, and service failures.
· Monitor fraud, waste, and abuse indicators.
· Ensure compliance with CMS, Medicaid, HIPAA, ADA, and state transportation regulations.
· Participate in internal and external audits.
· Assist with policy development and annual policy review cycles.
Quality oversight responsibilities often include payment validation, trip verification, complaint management, and audit monitoring.
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Financial & Contract Management
· Manage provider reimbursement structures and contract compliance.
· Monitor transportation costs, utilization, and budget adherence.
· Identify cost-saving opportunities while maintaining service quality.
· Review provider invoices, disputes, and reconciliation issues.
· Support financial forecasting and network expansion planning.
Common financial performance measures include:
· Cost per trip within budget targets
· Budget variance control
· Contract efficiency and documented savings
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Reporting & Analytics
· Prepare provider performance reports, scorecards, and executive summaries.
· Analyze network trends, capacity gaps, utilization patterns, and quality metrics.
· Present operational findings and recommendations to leadership.
· Maintain documentation for audits, credentialing, and compliance reporting.
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Required Qualifications
· Bachelor’s degree in Healthcare Administration, Business Administration, Logistics, Public Health, or related field preferred.
· Minimum 3–5 years of experience in:
o NEMT operations
o Healthcare network management
o Transportation management
o Medicaid managed care
o Provider relations or credentialing
· Knowledge of Medicaid transportation regulations and managed care operations.
· Experience with provider contracting and performance management.
· Strong understanding of HIPAA, ADA, and healthcare compliance standards.
· Proficiency with Microsoft Office Suite and transportation management systems.
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Preferred Qualifications
· Experience working with Medicaid brokers or managed care organizations.
· Knowledge of NEMTAC standards and transportation accreditation requirements.
· Experience with provider auditing and quality improvement programs.
· Bilingual communication skills preferred.
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Key Competencies
· Leadership & Relationship Management
· Provider Negotiation & Contracting
· Regulatory Compliance
· Operational Analytics
· Problem Solving & Decision Making
· Conflict Resolution
· Financial Acumen
· Communication & Presentation Skills
· Process Improvement
· Attention to Detail
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Performance Metrics
Performance may be evaluated using metrics such as:
· Network Adequacy
· Provider Retention Rate
· Credentialing Compliance
· On-Time Performance
· Complaint Resolution Time
· Audit Scores
· Cost per Trip
· Provider Satisfaction Scores
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Work Environment
· Hybrid or office-based environment with periodic provider site visits.
· Occasional travel required for provider audits, meetings, and operational oversight.
· May require after-hours support for escalated operational issues.
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· This role reports to the CEO with strong alignment with the COO, Director of Revenue Cycle and Provider Relations, CTO, and Chief Product Officer.
Minimum Required Education and Qualifications
· Bachelor’s degree in computer science, data engineering / analytics, business, public health, or related field from an accredited college or university.
· Data analytics, reporting, and presentation experience, including specific healthcare data systems (EMR) experience preferred.
· Advanced Excel, PowerBI, and other experience with data visualization tools required.
· Proactive and investigative leader who can visualize and anticipate needs, questions, outcomes, etc.
· Knowledge of Medicaid programs, Non-Emergency Medical Transportation (NEMT), public healthcare policy and compliance, and other healthcare industry specialty preferred.
· Be comfortable in a collaborative, high-production, meaningful-impact environment.
Travel Requirements
· Occasional statewide travel within Louisiana.
· Occasional overnight travel as required.
Pay: $55,000.00 - $68,000.00 per year
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Experience:
- Data analytics: 2 years (Preferred)
- Quality improvement: 2 years (Preferred)
Willingness to travel:
Work Location: In person
