Overview
Skills
Job Details
Title : Network QA Manager
Location : Remote
Duration : FT
Summary
The Network QA Manager is responsible for leading oversight operations, ensuring compliance with contractual, regulatory, clinical, and client requirements. This role manages end-to-end network oversight functions, client satisfaction monitoring, provider search tool performance, and provider panel card production to support organizational objectives and client commitments.
Key Responsibilities
- Oversight Management
Lead all Network Oversight functions and team members.
Ensure compliance with Service Level Agreements (SLAs), regulatory
requirements, and client contractual commitments.
Monitor performance metrics and implement corrective action plans as needed.
- Client Success Monitoring
Track, evaluate, and report client satisfaction and oversight outcomes.
Identify and resolve performance gaps through corrective action initiatives.
Develop reports and dashboards to present outcomes to leadership and
clients.
- Provider Search Tool Oversight
Manage vendor partner relationships, including contracting and issue resolution.
Oversee provider search tool functionality, accuracy, and usability.
Ensure timely updates and enhancements to improve provider access for clients and members.
- Panel Cards Production Manage production and distribution of provider panel cards in compliance with standards.
Oversee vendor performance, ensuring accuracy, and timely delivery.
Establish quality control measures for provider data integrity.
- Compliance and Oversight of Clinical Quality Measures
Coordinate with compliance and contracting departments limit exposure
Work with Medical Director to review and maintain effective clinical quality policies and procedures are in place.
Qualifications
- 7-10 years of experience in Network Management and or Group Health?
Experience working in or with Bill Review disciplines?
Strong written and verbal communications
Experience working in a matrixed organization and effective with multi-stakeholder management
Excellent relationship management and issue resolution skills
Enjoys managing talent at all levels; familiarity working with offshore teams a plus
Proven experience in vendor management
Excellent organizational, analytical, and communication skills.