Network Operations Remote Jobs in New Jersey (US)
This page tracks remote network operations openings that are location-eligible for New Jersey.
This page tracks remote network operations openings that are location-eligible for New Jersey.
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150
Hiring companies this week
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$23 - $158,875
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150 Jobs
115 Companies
Role Description This position is accountable for the Provider Network department’s core operational, data, and systems functions. This role will oversee Provider Network divisions including Provider Relations, Provider Data Management, Credentialing, and provider platform interoperability. This position leads both department-specific and cross departmental planning and execution efforts, to maintain high levels of performance in enterprise level and Provider Network level key performance indicators. This position is responsible for all lines of business (Medicaid, Medicare, Commercial) and leads in strong alignment with the company’s strategic plan, vision, and values. - Guide strategic initiatives for the Provider Network Operations division, including network setup and maintenance, provider data integrity, provider education and service, contract implementation performance, provider-related claims, provider setup and audits, corrective action plan assessment and closure, and provider directory accuracy improvements. - Collaborate with Provider Reimbursement Insights and Analytics Team to ensure success in meeting objectives. Develop, direct and execute efforts to meet Credentialing division objectives, ensuring compliance and operational excellence. - Develop and execute strategies for provider education and relationship management to enhance provider collaboration, engagement, and satisfaction within the Provider Relations Team. - Lead initiatives to ensure seamless integration and ongoing operational effectiveness of provider network platforms with legacy and emerging systems. Fostering partnerships with software vendors and internal stakeholders to optimize the interoperability of tools and streamline network operations. - Collaborate with IT teams and operational leaders to identify interoperability gaps and develop solutions to enhance system compatibility. - Ensure integrated systems support compliance with state, federal, and NCQA standards, as well as organizational policies. - Develop automated workflows and processes that ensure accurate synchronization of data across all platforms and departments. Guiding efforts to improve functionality via the deployment of LEAN methodologies and resources. - Strengthen relationship management frameworks to ensure consistent communication and support for provider partners. - Actively participate in department strategic planning, execution, resource allocation, and performance monitoring. Work with executive leadership to ensure processes, technology, and people resources are in place to achieve success in both key performance metrics and efficiency/stewardship targets. - Oversee and guide provider collaborative efforts in coordination with other key departments and leaders. - Guide division functional leaders to develop business plans that ensure successful initiatives have a positive impact on the member, provider partners and PacificSource. - Design and deliver provider education programs to ensure understanding of network policies, reimbursement processes, and regulatory requirements. - Regularly assess provider feedback and implement enhancements to address pain points and improve relationships. - In partnership with Operations, IT, Health Services, Analytics, Finance and other departments, collaborate to maximize the alignment and value of various initiatives. - Oversee the planning of annual IT work plans, initiative work plans, financial budgets, and resource needs for the role of supervisory departments. - Develop and implement coaching and training programs with division leaders to foster team growth. Oversee resources and prioritization of those resources as new competencies are needed when the company grows and expands into new markets. - Responsible for hiring, staff development, coaching, and performance reviews. Provide feedback, including regular one-on-one meetings and performance evaluations for direct reports. - Responsible for overall employee engagement enhancement within Provider Network to include implementation of education/programs and other desired cultural enhancements. - Oversee division budgets and spending. Monitor spending versus the planned budget throughout the year and assess appropriate corrective actions as needed. - Actively participate in Manager/Supervisor meetings, PRISM walks, internal committees and other key department activities and disseminate information as appropriate. Qualifications - Minimum of 8 years in healthcare operations required. - Management experience required. - Must have expertise in provider reimbursement methodologies, provider relations, data management and compliance, along with experience developing, communicating, and executing strategy in a matrixed organizational structure. Requirements - Bachelor’s degree in business, health care administration, finance, or related field required. - Candidates with an associate’s degree and 2 years of relevant experience, or a high school diploma and 4 years of relevant experience, in addition to the required minimum years of work experience will also be considered. Benefits - Accountable leadership. - Business & financial acumen. - Empowerment. - Influential Communications. - Situational Leadership. - Strategic Planning. Company Description PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.
Barclays is an international bank with products and services for consumers, corporations, and investment banking. The organization traces its history back to tw
Title: Connectivity Service Operations - Sr. Network Engineer Location: Building 400-Whippany Campus, Jefferson Park Full time Purpose of the role To effectively monitor and maintain the bank’s critical technology infrastructure and resolve more complex technical issues, whilst minimising disruption to operations. Accountabilities - Provision of technical support for the service management function to resolve more complex issues for a specific client of group of clients. Develop the support model and service offering to improve the service to customers and stakeholders. - Execution of preventative maintenance tasks on hardware and software and utilisation of monitoring tools/metrics to identify, prevent and address potential issues and ensure optimal performance. - Maintenance of a knowledge base containing detailed documentation of resolved cases for future reference, self-service opportunities and knowledge sharing. - Analysis of system logs, error messages and user reports to identify the root causes of hardware, software and network issues, and providing a resolution to these issues by fixing or replacing faulty hardware components, reinstalling software, or applying configuration changes. - Automation, monitoring enhancements, capacity management, resiliency, business continuity management, front office specific support and stakeholder management. - Identification and remediation or raising, through appropriate process, of potential service impacting risks and issues. - Proactively assess support activities implementing automations where appropriate to maintain stability and drive efficiency. Actively tune monitoring tools, thresholds, and alerting to ensure issues are known when they occur. Assistant Vice President Expectations - To advise and influence decision making, contribute to policy development and take responsibility for operational effectiveness. Collaborate closely with other functions/ business divisions. - Lead a team performing complex tasks, using well developed professional knowledge and skills to deliver on work that impacts the whole business function. Set objectives and coach employees in pursuit of those objectives, appraisal of performance relative to objectives and determination of reward outcomes - If the position has leadership responsibilities, People Leaders are expected to demonstrate a clear set of leadership behaviours to create an environment for colleagues to thrive and deliver to a consistently excellent standard. The four LEAD behaviours are: L – Listen and be authentic, E – Energise and inspire, A – Align across the enterprise, D – Develop others. - OR for an individual contributor, they will lead collaborative assignments and guide team members through structured assignments, identify the need for the inclusion of other areas of specialisation to complete assignments. They will identify new directions for assignments and/ or projects, identifying a combination of cross functional methodologies or practices to meet required outcomes. - Consult on complex issues; providing advice to People Leaders to support the resolution of escalated issues. - Identify ways to mitigate risk and developing new policies/procedures in support of the control and governance agenda. - Take ownership for managing risk and strengthening controls in relation to the work done. - Perform work that is closely related to that of other areas, which requires understanding of how areas coordinate and contribute to the achievement of the objectives of the organisation sub-function. - Collaborate with other areas of work, for business aligned support areas to keep up to speed with business activity and the business strategy. - Engage in complex analysis of data from multiple sources of information, internal and external sources such as procedures and practises (in other areas, teams, companies, etc).to solve problems creatively and effectively. - Communicate complex information. 'Complex' information could include sensitive information or information that is difficult to communicate because of its content or its audience. - Influence or convince stakeholders to achieve outcomes. All colleagues will be expected to demonstrate the Barclays Values of Respect, Integrity, Service, Excellence and Stewardship – our moral compass, helping us do what we believe is right. They will also be expected to demonstrate the Barclays Mindset – to Empower, Challenge and Drive – the operating manual for how we behave. What will you be doing? Barclays Services Corp. seeks Connectivity Service Operations - Sr. Network Engineer in Whippany, NJ (multiple positions available): - Responsible for managing Network Local Area Network/Wide Area Network/Metro Area Network infrastructure, Load balancer, Web proxies and Domain Name System appliances for the Barclays estate. - Responsible for Incident, Problem and Change Management for critical and major incidents. React quickly to live systems errors and service problems to minimize downtime and restore service. Taking lead in technical communication and focus for root cause identification and implementation of permanent fix where necessary. - Responsible for planning and implementation of minimal to significant changes based on the business requirement and maintenance activities in line with change management processes and governance. - Work with regional and global counterparts, Product Engineering, Product Managers and Service Managers for input and to understand influence new solutions and the on boarding of new services. - Ensure the integrity and stability of the production data network is maintained. - Ensure accurate network infrastructure support documentation is maintained. - Take responsibility for completing tasks, focusing on requirements and planning to meet stakeholder needs. - Keep and update knowledge of the bank's Infrastructure Products and Services. - May telecommute pursuant to company policies. [Hybrid role] Minimum Salary: $158,875 per year Maximum Salary: $160,000 per year The minimum and maximum salary/rate information above includes only base salary or base hourly rate. It does not include any other type of compensation or benefits that may be available. Barclays employees are eligible for a suite of a competitive and generous employee benefits, including medical, dental and vision coverage, 401(k), life insurance, and other paid leave for qualifying circumstances. This position is eligible for an incentive award.
• Support XGS-PON hardware, troubleshoot, diagnose, test, configure and upgrade lab, operational system, data center, public Wi-Fi, and customer networking equipment • Serve as incident commander for network incidents, coordinating triage, escalation, response, and stakeholder communication through to resolution • Own post-incident documentation, author official retrospectives and Reason for Outage reports, capturing root cause, timeline, impact, and corrective actions • Develop and maintain the internal knowledge base, training programs, and procedural documentation, partnering across teams to keep policies and procedures current • Manage team accounts, onboarding, and offboarding • Manage internal ticketing system for technical issues • Collaborate with the Customer Technical Support team to ensure issues are resolved within SLA • Configure and manage broadband service • Deploy and manage mass firmware updates to on-premises equipment and OLTs • Assist Network Engineers in performing data backups, disaster recovery operations, upgrades, and maintenance of core network equipment to support network availability • Remotely support onsite technicians and escalate issues when necessary • Oversee tracking and management of non-customer issues/tasks, maintain an internal project management tracking board • Support the outside plant team in activating fiber cabinets and troubleshooting fiber optics related issues • Coordinate with vendors to implement network solutions and upgrades, ensuring clear and timely communication across the team
Zayo provides bandwidth to the world’s most impactful companies, fueling the innovations that are transforming society.
• Supervise and coordinate activities for assigned workers. • Execute on operational standards and best practices. • Ensure proper escalation and resolution processes are followed. • Oversee the incident management process and drive ticket management analysis until closure. • Collaborate across multiple functions within the organization to drive resolution of outages. • Mentor and coach technicians at all levels. • Facilitate training sessions and create educational materials for NCC staff. • Communicate updates on network performance and critical incidents. • Manage workflows and prioritize tasks to ensure smooth NCC operations.
Clover is a healthcare technology company helping members live their healthiest lives with our Medicare Advantage plans.
• Hold accountability for the accuracy, regulatory compliance (CMS), and publication of the consumer-facing Provider Directory, implementing strict controls to minimize data discrepancies. • Serve as the end-to-end owner of the PDM Platform. Champion the data architecture strategies required to ingest diverse API feeds (NPPES, CAQH, provider rosters, webscraping) into our data warehouse, applying weighted scoring and business rules to build a high-fidelity provider data environment. • Partner closely with the Chief Medical Officer (CMO), who chairs the committee, to own the end-to-end business operations of the enterprise Credentialing Committee. Ensure monthly meetings are executed seamlessly and that our third-party credentialing vendor arrives fully prepared with all necessary cases, files, and documentation for review in compliance with NCQA and regulatory standards. • Act as the primary lead for the strategic oversight of our third-party credentialing partners and BPaaS operational vendors. Establish rigorous data-driven performance metrics, hold partners to high operational standards, and seamlessly synchronize external workflows with internal goals. • Spearhead the integration of advanced AI and Large Language Models (LLMs) to automate manual provider data updates, optimize validation pipelines, and proactively identify directory inaccuracies. • Directly manage, mentor, and scale a highly skilled, fully remote network operations team, fostering an inclusive culture centered on accountability, technological fluency, and precision. • Provide the overarching strategic vision for network operations. Act as an executive unblocker, driving rapid, successful resolution to open, complex projects across Clinical, Claims, Product, Compliance, and Configuration teams.
Role Description The Network Operations Center (NOC) Analyst is an entry level role responsible for providing support for Level 1 trouble isolation and repair for all Syniverse Global Networks, Products, Platforms, and Services. This role will work in a team environment and is accountable for providing resolution with sense of urgency and in correspondence with defined service level agreements. Key Responsibilities - Work as single point of contact for customer communications and escalations and ensures the performance of the network through monitoring of traffic, performance, and configuration. - Support the analysis, reporting, and action to resolve alerts generated by the internal surveillance tools. - Act as first line of contact for all Trouble Ticket issues, and maintain the shift logs. - Provide follow-up on change requests, incidents/Break-fixes and perform other scheduled activities within the SLA requirements. - Conduct proper maintenance of systems and ascertain compliance with security, safety, and environmental guidelines. - Provide support to troubleshoot and isolate incidents with vendors and service providers. Escalate according to Syniverse NOC processes. - Work closely with Tier-I counterparts to resolve and close events/incidents. - Provide input to shift reports and coordinate handover of incomplete activities to the oncoming shift. - Demonstrate and apply thorough understanding of the OSI (Open Systems Integration Model), operations of Network Monitoring Tools (e.g.: HP Network Node Manager, NetCool), and customer applications and components associated with each application. - Use IT Standard Operating Procedures (SOP), Work Instructions (WI) and Server support documentation for the Network Operations Center (NOC). Qualifications - No previous experience required. - Preferred Networking and Application Certifications from an accredited Trade School or Academy. - Preferred to have one or more of the following: Cisco Certified Entry Networking Technician (CCENT), Juniper Networks Certified Associate (JNCIA), Cisco Certified Network Associate (CCNA), ITIL v3 Foundations Certification. Requirements - Use of the English language in verbal and written communications is a requirement for this position. - Works in shifts to provide onsite 24x7 coverage to respond to customer and internal Syniverse issues and is flexible to work beyond stipulated hours. - Exceptional customer service skills and demeanor, along with the ability to communicate with both technical and non-technical clients. Benefits - Competitive total compensation. - Flexible/remote work options. - Leadership team committed to fostering an inclusive, collaborative, and transparent organizational culture.
Koniag Government Services (KGS) is an Alaska Native Owned corporation supporting the values and traditions of our native communities through an agile employee and corporate culture that delivers Enterprise Solutions, Professional Services and Operational Management to Federal Government Agencies.
Role Description Tuknik Government Services, LLC, a Koniag Government Services company, is seeking a Network Administrator Tier 2 (Network Operations Center) with a Top-Secret security clearance to support TGS and our government customer. - Develop an understanding of our existing IT infrastructure while actively searching for improvement areas - Streamline workflows by implementing inventive technical solutions - Engage with stakeholders, updating them on IT development processes and costs - Drive organization-wide process optimization - Meet short- and long-term business goals - Evaluate existing and emerging technologies on a regular basis Qualifications - Excellent analytical skills - Knack for finding creative solutions - Solid understanding of IT topics - Keen attention to detail - Strong interpersonal skills - Excellent verbal and written communication skills Requirements - Top Secret security clearance - Design and test technical architecture - Connect with subject matter experts (SMEs) to identify problem areas - Propose IT solutions to company challenges - Develop and review code - Ensure comprehensive IT documentation - Partner with teams across business functions to drive organizational efficiency Preferred Qualifications - Familiarity with coding languages, operating systems, and databases - Understanding of process optimization and deployment - Experience working with various infrastructure platforms - Ability to organize and prioritize critical projects - Interest in new and developing technologies - Willingness to work closely with various business units Benefits - Competitive compensation - Extraordinary benefits package including health, dental, and vision insurance - 401K with company matching - Flexible spending accounts - Paid holidays - Three weeks paid time off - And more Company Description Koniag Government Services (KGS) is an Alaska Native Owned corporation supporting the values and traditions of our native communities through an agile employee and corporate culture that delivers Enterprise Solutions, Professional Services and Operational Management to Federal Government Agencies. As a wholly owned subsidiary of Koniag, we apply our proven commercial solutions to a deep knowledge of Defense and Civilian missions to provide forward leaning technical, professional, and operational solutions. KGS enables successful mission outcomes for our customers through solution-oriented business partnerships and a commitment to exceptional service delivery. We ensure long-term success with a continuous improvement approach while balancing the collective interests of our customers, employees, and native communities. For more information, please visit www.koniag-gs.com .
Role Description - Provides excellent customer service to all customers. - Fields incoming help requests from end users via a variety of intakes (phone, walkup, email, etc). - Documents all pertinent end user identification information, including name, department, contact information, and nature of request or incident. - Records, tracks, and documents the Incidents and requests in the ticketing tool. Ensure all successful and unsuccessful decisions made, and actions taken, through to final resolution have been captured in the ticket. - Accesses software updates, drivers, knowledge bases, and frequently asked questions resources on the Internet to aid in problem resolution. - Performs hands-on fixes at the desktop level, including installing and upgrading software, installing hardware, implementing file backups, and configuring systems and applications. - Performs preventative maintenance, including checking and cleaning of workstations, printers, and peripherals. - Evaluate documented resolutions and analyze trends for ways to prevent future problems. - Identifies and escalates critical incidents. - Ability to work flexible schedules, including day and mid/swing shifts. Qualifications - HS Diploma or equivalent required. - Relative work experience. - COMP TIA A+ preferred. Requirements - Working knowledge of computer systems and web browsers, with the ability to troubleshoot common technical issues. - Strong written and oral communication skills. - Interpersonal skills, with a focus on rapport-building, listening, and questioning skills. - Strong documentation skills. - Ability to absorb and retain information quickly. - Experience supporting VOIP telecom devices. - Basic knowledge of network routing and protocols. - Ability to present ideas in user-friendly language. - Highly self-motivated and directed. - Keen attention to detail. - Analytical and problem-solving abilities. - Ability to prioritize and execute tasks in a high-pressure environment. Benefits - Medical and dental care benefits. - 401k. - PTO. - Parental leave. - Bereavement leave.
Lumen Technologies is self-described as a global company of 40,000+ professionals empowering businesses, government, and communities to “produce amazing things.” Driven by the
Role Description Manages the work of subordinate supervisors and/or exempt management employees. Leads functional area within a business unit. Accountable for results, costs, methods, and staffing of functional area. Establishes and assures adherence to budgets, schedules, work plans and performance requirements. Manages network maintenance at the customer site or remotely from a company location through subordinate supervisors and/or exempt employees. Responsible for planning, organizing, and directing all network maintenance operations including installation, service, and changes. Establishes network operations schedules, work plans and ensures performance requirements are met. Responsible for all training requirements for personnel. Responsible for all reporting aspects of their particular center and function for both center results and individual performance. Strong coaching and mentoring skills are a requirement. The position requires excellent customer service skills. They must be effective in providing feedback in a timely manner. They must possess excellent communication skills. Main Responsibilities - Will lead teams providing 7x24x365 support in the following areas: - Surveillance - network coverage (including monitoring all switching, routing, trunking, and data networking equipment throughout wireline, long distance, and CLEC business units). - Software and Hardware Support – acting as an initial point of contact for field personnel and equipment vendors (with specialization in certain areas and providing on-site help as needed). - Technical Support – in-depth traffic analysis, testing and acceptance of all switching/routing network products that go on-line. This management position must have a strong understanding of the OSI model. They must understand the interoperability between the layers and its impacts to services and the network performance. This position requires the ability to articulate issues that arise from implementation, design, repair, surveillance, and performance management to upper leadership, peer organizations, impacted internal business units and most importantly our customers. This manager position will need to understand the evolution of technology and impacts to current infrastructure, services, network reliability, customer requirements etc. This manager must always act with a sense of urgency and have a high level of engagement with their supervisors and team members. Internal/External Contacts - Executive level correspondence on network events, resolution and forward looking corrective plans. - Account teams – direction of the network, relay information pertaining to outages and resolutions, provide Engineering study results, and assist with special requests from customers. - Central Office Personnel – relay information pertaining to outages and resolutions, provide support for central office problems, establishing and maintaining traffic port connections in the switch, and to provide support on traffic packages in the switch. - Field Operations – to assist with repair and maintenance issues. - Network Planning – assist with field trials for new technologies, support standardization of the network, and provide traffic data for network design projects. - Vendor Technology Management for guidance and feedback on the vendor’s products and services. - Technical Support Centers for the various switch manufacturers – provide support for switch issues and software programming of new measurements and report features. - Product – to provide guidance and feedback on new products and services. Help identify and risks or issues that may impact customer service and product implementation etc. - Accounting – to provide total office measurements for reporting to various State Commissions. - External Vendors – act as the single point of contact for support of network elements. Qualifications - Bachelor’s degree in Engineering or related field or the equivalent in training and experience. - Minimum 6 years work experience with communications networks or the equivalent in training and experience. - Three (3) years management experience with proven leadership abilities. - Ability to communicate courteously and professionally with outside contacts and other employees, including various levels of staff and management. - Ability to handle situations involving conflict while promoting a positive company image. - Excellent verbal and written communication skills. - Goal and detail-oriented. - Ability to perform under emergency conditions and handle multiple tasks simultaneously with frequent interruptions. - Self-motivated and able to work with minimal supervision. - Strong analytical or organizational skills. - Ability to work weekends and nights when necessary. - Skilled in the use of operating personal computers utilizing Microsoft Word, Excel, Access, and Outlook programs. - Read and follow technical instructions. Requirements - A candidate for this position should be able to work independently, with peers, customers, and supplier teams; to prioritize numerous deliverables on multiple projects; interface directly with all levels of management; and to develop and schedule reports through multiple custom databases. - Must be willing to submit and successfully complete Government Agency Clearance request. Compensation This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Individual pay is based on skills, experience and other relevant factors. - $132,232 - $176,310 in these states: AL, AR, AZ, FL, GA, IA, ID, IN, KS, KY, LA, ME, MO, MS, MT, ND, NE, NM, OH, OK, PA, SC, SD, TN, UT, VT, WI, WV, WY - $138,844 - $185,124 in these states: CO, HI, MI, MN, NC, NH, NV, OR, RI - $145,456 - $193,940 in these states: AK, CA, CT, DC, DE, IL, MA, MD, NJ, NY, TX, VA, WA Benefits Lumen offers a comprehensive package featuring a broad range of Health, Life, Voluntary Lifestyle benefits and other perks that enhance your physical, mental, emotional and financial wellbeing. We're able to answer any additional questions you may have about our bonus structure (short-term incentives, long-term incentives and/or sales compensation) as you move through the selection process.
Molina Healthcare is a Fortune 500 managed care company with a storied history that dates back to 1980 and the opening of a medical clinic by Dr. C. David Molina. As an employer, M
Role Description Leads and directs team responsible for network operations and contracting activities. Supports network strategy and development with respect to adequacy, financial performance and operational performance. Also responsible for negotiating complex contracts that are strategically critical to plan/product success, including but not limited to: - Alternative payment models (APMs) - Value-based payment (VBP) contracts - Capitated payments for hospitals, independent physician associations (IPAs), and complex behavioral health arrangements Establishes and maintains a distinct high-performing and adequate network of compassionate and culturally sensitive providers aligned with Molina's mission, vision and values. Qualifications - At least 8 years of experience in health care to include experience in provider network management/contracting, health care operations, and/or government-sponsored programs, and at least 6 years of senior level network operations experience, or equivalent combination of relevant education and experience. - At least 3 years of management/leadership experience. - Extensive experience in the health insurance industry. - Track record of strong relationships with hospitals, provider groups, and independent physician associations (IPAs). - Knowledge of reimbursement methodologies across all lines of business (Medicaid, Medicare, Marketplace). - Strong experience with various managed health care provider compensation methodologies. - Excellent negotiation and relationship building capabilities. - Ability to navigate complex regulatory environments. - Strong data-driven decision-making skills, and analytical abilities. - Strong organizational skills and attention to detail. - Ability to work cross-functionally with internal/external stakeholders in a highly matrixed organization, and influence business decisions. - Ability to manage multiple tasks and deadlines effectively. - Strong project management skills. - Excellent verbal and written communication skills, and ability to present at an executive level. - Microsoft Office suite and applicable software programs proficiency. Requirements - Develops and implements provider network and contracting strategies; identifies specialties and geographic locations to concentrate resources for the purpose of establishing a sufficient network of participating providers to serve the health care needs of the plan’s membership. - Develops and maintains a market-specific provider reimbursement strategy consistent with reimbursement tolerance parameters (across multiple specialties/geographies); oversees the development of new reimbursement models, collaborating with Molina corporate and legal departments. - Develops and maintains a system to track contract negotiation activity on an ongoing basis; utilizes and oversees departmental training on the contract management system. - Directs the preparation and negotiations of provider contracts and oversees negotiation of contracts in concert with established company templates and guidelines related to contracting with physicians, hospitals, and other health care providers. - Contributes as a key member of the senior leadership team and other committees responsible to address the strategic goals of the department and organization. - Oversees the maintenance of all provider contract information, provider contract templates and ensures that all contracts negotiated can be configured in the QNXT system; collaborates with legal and corporate on an as needed basis to modify contract templates to ensure compliance with all contractual and/or regulatory requirements. - Oversees plan-specific fee schedule management. - Develops strategies to improve EDI/MASS rates. - Provides oversight of provider services and coordinates activities with provider associations and joint operating committees (JOCs). - Provides accountability for delegation oversight function in the plan. - Provides oversight of the provider network administration area including: provider information management, and business analyses of contracts and benefits to support accurate configuration for claims payment. - Oversees all provider/member issue prevention, research and resolution and provides oversight of the provider/member appeals and grievance process. - Coordinates with enrollment growth to ensure that Molina grows faster (profitable growth) than competitors in key provider practices. - Hires, trains, manages and evaluates team member performance - provides coaching, development, and recognition; ensures ongoing appropriate staff training, holds regular team meetings, and drives communication and collaboration. Benefits Molina Healthcare offers a competitive benefits and compensation package. Company Description Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
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