Provider Network Manager at Verda Healthcare Inc

Verda Health Plan of Texas has a contract with the Center of Medicaid and Medicare Services (CMS) and a state license with the Texas Department of Insurance for a Medicare Advantage Prescription Drug (MAPD) plan. We are committed to the idea that healthcare should be easily and equitably accessed by all. Our mission is to ensure that underserved communities have access to health and wellness services, and receive the support needed to live a healthy life that is free of worry and full of joy. We are looking for a Provider Network Manager to join our growing company with many internal opportunities.

Are you ready to join a company that is changing the face of health care across the nation? Verda Healthcare, Inc is looking for people like you who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to improving the lives of our Medicare members. Our vision incorporates value-based health care that works. We value diversity.

Align your career goals with Verda Healthcare, Inc and we will support you all the way.

Position Overview

The Provider Network Manager (PNM) serves as the primary source of Provider Relations for assigned territories, which may change from time-to-time with targeted providers in an assigned territory. The PNM coordinates with Network Development team to initiate conversations to introduce Verda Healthcare and to develop communications, with the objective to secure participation agreements in accordance with company policies and procedures

The PNM plays a critical role in increasing Verda Healthcare’s brand with providers by identifying, researching, vetting, and developing an assessment of the provider and the overall business landscape, appropriately identifying providers that align with Verda Healthcare. This individual also supports provider network growth strategies and provider network development in all markets.

This position reports to the Senior Director of Provider Network as part of Verda Healthcare, Inc.

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 – Responsible for receiving, validating, and updating 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; driving 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, including but not limited to resolve provider issues and streamline processes. Provide high-level recommendations to enhance operational workflows and service delivery.
• 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 plan for gaps in access and communicate network performance to IPAs, addressing network gaps and resolution.
• 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.
• Perform other duties as assigned.

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: Ability to 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: Skilled at identifying issues, analyzing root causes, and collaborating on timely resolutions.

· Organizational Agility: Able to navigate cross-functional teams and balance provider needs with organizational priorities.

· Attention to Detail: Ensures accuracy in roster management, reporting, and compliance-driven processes.

· Project Management: Capable of planning, coordinating, and executing multiple provider initiatives simultaneously.

· Customer Service Orientation: Committed to improving provider experience while supporting organizational objectives.

Verda cares deeply about the future, growth, and well-being of its employees. Join our team today!

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
• Standard business hours Monday to Friday/weekends as needed
• Occasional travel may be required for meetings and training sessions.

Ability to commute/relocate:

• Reliably commute or planning 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.