QA Network Manager-Provider Network

Title : Network QA Manager

Fulltime/Direct Hire

Remote

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

1. 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.

2. 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.

3. 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.

4. 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.

5. 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.