Title : Network Product Manager
Location : Remote
Duration : FT
Summary
The Network Product Manager is a strategic leadership role responsible for defining, building, and evolving Client’s Medical Bill Processing, PPO Repricing, and Cost Containment Network products. This role owns the network product vision and roadmap, including the systematic evaluation, selection, and optimization of PPO networks and sub-networks, ensuring MedRisk partners with the strongest and most effective network ecosystem in the market.
The role will position "the client" as the industry leader in Medical Bill Review, repricing, and cost containment solutions, balancing national scale with regional strength and specialty expertise. Success requires deep strategic thinking across network evaluation frameworks, provider access, pricing effectiveness, compliance, and product differentiation, in close partnership with Operations, Sales, Legal, and Technology teams.
Key Responsibilities
Product Strategy & Vision
- Define and execute the long-term product strategy for Medical Bill Review, repricing, and PPO network solutions.
- Establish MedRisk as a thought leader and innovator in medical cost containment and network optimization.
- Develop and articulate a clear value proposition for national, regional, and specialty network offerings.
- Continuously assess market trends, regulatory developments, and competitive dynamics to evolve product strategy.
Network & Sub-Network Evaluation and Partner Strategy
- Own the end-to-end process for evaluating PPO networks and sub-networks, including national, regional, and specialty offerings.
- Develop and maintain a formal network evaluation framework that assesses:
- Provider access and geographic coverage
- Repricing performance and savings consistency
- Provider contract quality and fee schedules
- Data transparency, reporting, and operational integration
- Compliance, defensibility, and audit support
- Identify the optimal mix of networks and sub-networks to maximize savings, access, and client outcomes.
- Lead network partner selection, rationalization, and ongoing performance reviews, including recommendations to add, sunset, or replace networks.
- Partner with Legal and Compliance to evaluate contractual terms, regulatory risk, and network defensibility.
Network Strategy & Optimization
- Design and oversee a tiered network strategy that balances:
- National PPO coverage
- Regional market strength
- Specialty network depth
- Identify coverage or performance gaps and define strategies to strengthen network reach and effectiveness.
- Ensure network configurations are optimized for client needs, jurisdictional requirements, and specialty use cases.
Medical Bill Review & Repricing Enablement
- Ensure network and sub-network selections directly support medical bill review workflows, repricing accuracy, and cost containment goals.
- Collaborate with Operations and Clinical teams to ensure network design supports accurate repricing, defensibility, and dispute resolution.
- Drive improvements that enhance repricing yield, turnaround time, and savings predictability.
Cross-Functional Leadership
- Work closely with Sales and Client Management to support go-to-market strategy, pricing models, and client-facing network positioning.
- Translate network evaluation outcomes into clear internal guidance and external messaging.
- Partner with Technology and Data teams to define requirements for network performance analytics, benchmarking, and reporting tools.
- Collaborate with Legal and Compliance to ensure network strategies meet all regulatory and contractual standards.
Performance Management & Metrics
- Define and monitor KPIs related to network and sub-network performance, including:
- Repricing savings and hit rates
- Network access and penetration
- Provider participation and overlap
- Client satisfaction and retention
- Use performance insights to drive continuous optimization of network partnerships and product strategy.
Qualifications & Experience
- Bachelor’s degree required; MBA or advanced degree preferred.
- 7–10+ years of experience in healthcare product management, PPO networks, medical bill review, or cost containment.
- Demonstrated experience evaluating, selecting, and managing PPO networks and sub-networks.
- Strong understanding of:
- PPO network contracting and fee structures
- Medical billing and reimbursement methodologies
- Workers’ compensation and/or complex reimbursement environments (preferred)
Core Competencies
- Strategic and analytical thinking
- Network evaluation and decision frameworks
- Healthcare reimbursement expertise
- Executive communication and influence
- Data-driven decision-making
- Ability to balance strategic vision with operational execution
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