Provider Network Manager Job Description [Updated for 2025]

In today’s healthcare landscape, the importance of Provider Network Managers is more apparent than ever.

As healthcare continues to evolve, the demand for skilled professionals who can manage, expand and fortify our network of healthcare providers grows.

But let’s delve deeper: What’s truly expected from a Provider Network Manager?

Whether you are:

• A job seeker trying to understand the nuances of this role,
• A hiring manager shaping the ideal candidate profile,
• Or simply intrigued by the intricacies of provider network management,

You’re in the right place.

Today, we present a customizable Provider Network Manager job description template, designed for effortless posting on job boards or career sites.

Let’s dive right into it.

Provider Network Manager Duties and Responsibilities

Provider Network Managers are responsible for managing and expanding the network of healthcare providers for a healthcare institution or insurance company.

They ensure that the network meets the quality standards and requirements of the organization while also maintaining good relationships with providers.

The duties and responsibilities of a Provider Network Manager may include:

• Developing and implementing network development strategies for the expansion and retention of the provider network
• Negotiating contracts with healthcare providers
• Ensuring that the provider network meets the quality, cost, and coverage standards of the organization
• Building and maintaining relationships with healthcare providers and resolving any issues that may arise
• Conducting regular reviews and audits of the provider network to ensure compliance with regulatory requirements
• Coordinating with other departments such as the claims department to address any issues related to provider services
• Monitoring provider performance and implementing corrective action plans if necessary
• Facilitating communication between healthcare providers and the organization, including providing training and education on policies and procedures
• Preparing and analyzing reports on network performance and providing recommendations for improvement
• Maintaining accurate and up-to-date provider data in the organization’s systems

 

Provider Network Manager Job Description Template

Job Brief

We are searching for a skilled Provider Network Manager to build and maintain a strong network of healthcare providers.

Responsibilities include negotiating contracts, maintaining relationships with healthcare providers, implementing provider services, and ensuring network growth.

The ideal candidate should be knowledgeable about the healthcare industry, be adept at contract negotiation and have an understanding of healthcare laws and regulations.

The goal is to ensure that our network of providers is robust, efficient, and focused on patient care.

 

Responsibilities

• Negotiate contracts with medical service providers
• Develop and manage relationships with healthcare providers
• Ensure the network meets healthcare quality standards
• Implement provider services according to agreements and contracts
• Maintain the provider database and use it to monitor and analyze provider activity
• Monitor network adequacy and ensure network growth
• Resolve any issues that arise with providers
• Ensure compliance with healthcare laws and regulations
• Manage and coordinate with the provider relations team
• Conduct regular provider meetings to communicate information and address concerns

 

Qualifications

• Proven work experience as a Provider Network Manager, Healthcare Administrator or similar role
• Knowledge of healthcare regulations and medical contracts
• Experience in negotiation and network management
• Strong knowledge of medical coding, billing processes and provider credentialing
• Excellent communication, leadership and organizational skills
• Strong analytical skills and problem-solving abilities
• BSc degree in Healthcare Administration, Business Administration or a related field

 

Benefits

• 401(k)
• Health insurance
• Dental insurance
• Retirement plan
• Paid time off
• Professional development opportunities

 

Additional Information

• Job Title: Provider Network Manager
• Work Environment: Office setting with occasional travel for provider meetings or industry events.
• Reporting Structure: Reports to the Director of Provider Networks.
• Salary: Salary is based upon candidate experience and qualifications, as well as market and business considerations.
• Pay Range: $85,000 minimum to $135,000 maximum
• Location: [City, State] (specify the location or indicate if remote)
• Employment Type: Full-time
• Equal Opportunity Statement: We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
• Application Instructions: Please submit your resume and a cover letter outlining your qualifications and experience to [email address or application portal].

 

What Does a Provider Network Manager Do?

A Provider Network Manager works within the healthcare industry, typically for insurance companies, hospitals, or health systems.

Their primary role is to develop and maintain a network of healthcare providers that align with their organization’s needs and goals.

They are responsible for negotiating contracts with healthcare providers, which includes hospitals, doctors, clinics, and specialists, ensuring that the terms are fair, competitive, and adhere to healthcare regulations and standards.

Provider Network Managers also analyze the performance of the existing provider network, identifying gaps in services or areas where the network can be expanded.

This requires them to constantly monitor market trends and stay updated with changes in healthcare policies and regulations.

They work closely with healthcare providers to resolve any issues or concerns, fostering strong relationships to ensure the providers remain within the network.

Additionally, they may also oversee the enrollment process of new providers, ensuring that all necessary credentials and documents are in order, and the providers meet the quality standards set by the organization.

 

Provider Network Manager Qualifications and Skills

A proficient Provider Network Manager should have the skills and qualifications that align with your job description, such as:

• Strong interpersonal skills to establish and maintain productive relationships with healthcare providers and to negotiate contracts effectively
• Excellent communication skills for conveying network changes, contractual terms, and other necessary information to providers and internal staff
• Problem-solving skills to address provider concerns and issues, and to devise appropriate solutions
• Strategic planning and organizational skills to develop and manage provider networks that meet the needs of the organization and its members
• Knowledge of healthcare regulations and standards to ensure compliance in all activities
• Ability to analyze data and use it to make informed decisions about network composition, provider performance, and other key metrics
• Strong leadership and team-building skills to manage and motivate staff, and to collaborate effectively with other departments
• Experience in project management to handle multiple projects simultaneously and meet deadlines
• Proficiency in using healthcare management systems and other relevant computer software for data management and reporting.

 

Provider Network Manager Experience Requirements

The role of a Provider Network Manager generally requires substantial industry experience.

Candidates for this position are usually required to have at least 3 to 5 years of experience working in a healthcare setting, specifically in network management, or related fields such as health services administration, contract negotiation, or provider relations.

Entry-level candidates can gain relevant experience through roles such as Provider Relations Associate or Network Administrator.

They can also benefit from experience in healthcare consulting, analytics, or operations.

Candidates with more than 5 years of experience often have a deeper understanding of provider network strategies, contract negotiation, and the regulatory environment.

This experience is typically gained in roles such as Provider Network Specialist, Network Development Manager or Contract Manager.

For those with more than 7 years of experience, they may have acquired leadership experience and have a proven track record in managing provider networks, strategy development, and achieving cost-effective results.

Such candidates are generally ready for senior roles in provider network management.

In addition to the mentioned experience requirements, a bachelor’s degree in health administration, business, or a related field is typically required, though a master’s degree can enhance job prospects.

 

Provider Network Manager Education and Training Requirements

Provider Network Managers typically require a bachelor’s degree in healthcare administration, business administration, or a related field.

They must have knowledge of healthcare systems, insurance, and regulations, which can be gained through coursework or experience in a healthcare setting.

In addition, it is beneficial for these professionals to have understanding of network management, contract negotiation, and provider relations.

This might be gained through additional coursework or on-the-job experience.

Many employers prefer candidates with a master’s degree in healthcare administration, business administration or related field, particularly for managerial roles.

Certifications such as Certified Provider Credentialing Specialist (CPCS) or Certified Professional in Healthcare Quality (CPHQ) may also be beneficial.

These certifications demonstrate a higher level of expertise in the field and dedication to continued learning.

Provider Network Managers often need several years of experience in a healthcare setting, with some positions requiring experience in a supervisory or managerial role.

Continual training and education is necessary as healthcare regulations and technologies constantly evolve.

This can be achieved through seminars, workshops, or additional coursework.

 

Provider Network Manager Salary Expectations

A Provider Network Manager typically earns an average salary of $85,000 (USD) per year.

However, this can vary greatly depending on the individual’s level of experience, the size of the network they manage, their educational qualifications, and the location in which they work.

 

Provider Network Manager Job Description FAQs

What skills does a Provider Network Manager need?

A Provider Network Manager needs strong organizational and project management skills to manage large networks and coordinate with various stakeholders.

They also need excellent communication skills to negotiate contracts and handle disputes.

Analytical skills are also necessary to evaluate network performance and make necessary improvements.

Knowledge of healthcare systems and relevant regulations is important as well.

 

Do Provider Network Managers need a degree?

Most Provider Network Managers are required to have a bachelor’s degree in business, health administration, or a related field.

Some positions may require a master’s degree or equivalent experience in healthcare administration.

Additionally, knowledge of managed care, Medicaid, and Medicare is often needed.

 

What should you look for in a Provider Network Manager’s resume?

When looking at a Provider Network Manager’s resume, you should check for degrees in relevant fields and experience in healthcare or network management.

Look for experience in contract negotiation and network development.

Strong analytical and problem-solving skills are a plus, as well as the ability to work effectively with diverse groups of professionals.

 

What qualities make a good Provider Network Manager?

A good Provider Network Manager is a strong leader with excellent communication skills.

They should be able to develop and maintain professional relationships with providers.

Analytical thinking, decision-making skills, and the ability to handle high-pressure situations are also important.

They should also have a thorough understanding of healthcare systems, laws, regulations, and policies.

 

Is it difficult to hire Provider Network Managers?

The process of hiring a Provider Network Manager can be challenging due to the specific combination of skills and experience required.

The candidate needs to have knowledge of the healthcare industry, excellent networking skills, and experience in managing provider networks.

Therefore, finding a candidate who possesses all these qualities might take time.

 

Conclusion

And there we have it.

Today, we’ve unveiled the true essence of being a provider network manager.

Surprise!

It’s not just about managing provider networks.

It’s about shaping the future of healthcare, one provider relationship at a time.

Armed with our comprehensive provider network manager job description template and real-world examples, you’re ready to take the plunge.

But why end your journey here?

Delve further with our job description generator. It’s your ultimate tool for creating meticulously detailed job listings or honing your resume to perfection.

Always bear in mind:

Every provider relationship is a vital piece of the healthcare puzzle.

Let’s shape that future. Together.

How to Become a Provider Network Manager (Complete Guide)

Satisfaction Guaranteed: Jobs That People Are Happy to Have

Work That Makes You Smile: Fun Jobs with Impressive Pay

AI’s Limit: The Careers That Stay Human

The Calm Before, During, and After the Workstorm: Ultimate Low-Stress Jobs