Manager, Managed Care Operations

1 week ago

Nashville, United States ArchWell Health Full time
Job Summary:

The Manager, Managed Care Operations is a pivotal member of the Operations team at ArchWell Health. Their primary role is to Manage the Member Services Team and the operational functions related to provider data management and member assignment. They will also support implementation and operational functions related to payor relationships in conjunction with the leader of Managed Care Operations.

Duties/Responsibilities:
  • Lead and develop the Member Services team strategy, and continue to build out the processes surrounding member attribution
  • Support of payor contracts, payor relationships, provider data management and directory maintenance.
  • Provide support to market leadership teams related to membership attribution.
  • Accountability for speed and completeness of member attribution
  • Daily performance management from a KPI perspective and frequent operational review and status reporting to management
  • Ongoing support and development of Member Services team initiatives, KPIs, and reporting needs in collaboration with internal and external stakeholders
  • Identify root causes with member attribution and partner with internal leaders and payors to drive improvements
Required Skills/Abilities:
  • In-depth knowledge of provider network operations from a payor perspective and experience driving successful relationships between carriers and providers
  • Working knowledge of credentialing, provider data management, provider directories, Medicare Advantage, and membership attribution
  • Working knowledge of provider/payor ACO or risk contracts
  • Project management and communication skills
  • Skilled facilitator with the ability to manage internal and external stakeholders, ensuring decision-making and timely next steps
  • Ability to build relationships with leadership, resources, and stakeholders, including negotiation, influencing, communication, and trust
  • Ability to travel as needed, up to 10%
Minimum Qualifications:
  • Bachelors' Degree (strongly preferred), or equivalent experience
  • 5+ years of healthcare experience required
  • 3+ years prior experience with insurance carrier(s) required
  • 2+ years of leadership experience strongly preferred
  • Demonstrated knowledge of health plan operations, network management, provider directory loads, and member attribution
  • Experience in consulting, managed care, and/or healthcare provider/payer settings (preferred)
  • Embodies and serves as a role model of ArchWell Health's Values:
    • Be compassionate
    • Strive for excellence
    • Earn trust
    • Show respect
    • Stay resilient
    • Always do the right thing
About ArchWell Health:

At ArchWell Health, we're creating a community of caring designed to help our members stay healthy and engaged. By focusing on a strong provider-patient relationship, routine wellness, and staying active, our members enjoy a higher level of care and better quality of life after the age of 60. Everything we do is for seniors. We believe seniors should be heard, listened to, and given ample time by their physicians to live well later in life.

Our value-based care model is designed to prevent illnesses while keeping members healthy and happy in every aspect of their life. We deliver best-in-class primary care at comfortable, accessible neighborhood centers where older adults can feel at home and become part of a vibrant, wellness-focused community. We're passionate about caring for older adults and united by the belief that caring has the power to change everything for our members.

ArchWell Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification.

Other details
  • Job Family Operations
  • Pay Type Salary


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