Overview
Manages and maintains relationships with an assigned portfolio of contracted and prospective providers, serving as a primary liaison between VNS Health Plans and provider organizations. Responsible for supporting provider engagement, operational performance, contract implementation, education, and resolution of provider-related issues. Works collaboratively with internal departments and provider leadership to address complex operational, contractual, claims, compliance, quality, and service-related matters. Monitors provider needs and performance, identifies trends and opportunities for improvement, and coordinates appropriate follow-up and resolution. The role requires general direction, strong relationship management skills, knowledge of managed care operations and government-sponsored programs, and the ability to effectively navigate and coordinate across multiple internal and external stakeholders.
What We Provide
- Referral bonus opportunities
- Generous paid time off (PTO), starting at 20 days of paid time off and 9 company holidays
- Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
- Employer-matched 401k retirement saving program
- Personal and financial wellness programs
- Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care and commuter transit program
- Generous tuition reimbursement for qualifying degrees
- Opportunities for professional growth and career advancement and CEU credits
What You Will Do
- Manages an assigned portfolio of provider relationships, serving as a primary point of contact for provider leadership and key stakeholders and maintaining ongoing engagement to support strong provider relationships and network performance.
- Supports the implementation and ongoing administration of provider agreements, including provider education, contract requirements, operational expectations, demographic updates, renewals, and coordination with Contracting and Network teams.
- Educates providers on VNS Health Plans policies, procedures, contractual requirements, government program requirements, eligibility, operational processes, and other health plan initiatives.
- Monitors provider performance, identifies trends, gaps, discrepancies, and opportunities for improvement, and collaborates with internal and external stakeholders to develop and implement appropriate resolutions.
- Coordinates resolution of complex provider issues involving claims, billing, configuration, credentialing, contracting, quality, compliance, utilization, member service, and other operational matters, while maintaining ownership of the provider relationship through resolution.
- Serves as a liaison between providers and internal departments, facilitating communication and coordinating cross-functional efforts to address provider concerns and ensure timely follow-up.
- Leads and/or participates in provider meetings, business reviews, education sessions, site visits, and other provider engagement activities; prepares relevant materials and communicates organizational priorities and expectations.
- Coordinates provider-related initiatives and special projects, including implementation of new programs, regulatory requirements, operational changes, and other health plan initiatives impacting the provider network.
- Reviews provider data, reports, and other available information to identify discrepancies, trends, and potential areas of risk and escalating issues to the appropriate internal stakeholders.
- Partners with Compliance and other internal departments support Department of Health, regulatory, contractual, and internal audits and assist with provider follow-up and corrective actions as appropriate.
- Maintains accurate and timely documentation of provider interactions, activities, issues, and follow-up within designated systems and tools.
- Provides feedback to internal stakeholders regarding provider concerns, operational barriers, recurring issues, and opportunities to improve provider processes and the overall provider experience.
- Maintains current knowledge of VNS Health Plans products, provider network operations, applicable Medicare and Medicaid requirements, regulatory expectations, and organizational policies and procedures.
Qualifications
Licenses and Certifications:
Drivers license required
Education:
Bachelor's Degree or equivalent related work experience and relevant professional experience, preferably in healthcare, business, public health, health services, or a related field required
Work Experience:
Minimum three years of experience in provider relations, account management, managed care, healthcare operations, network management, contracting, or a related healthcare field required
Working knowledge of government-sponsored healthcare programs, including Medicare and Medicaid, and their impact on provider operations, reimbursement, eligibility, and regulatory requirements preferred
Prior experience in Provider Relations, Provider Network Management, Account Management, Contracting, or a related healthcare function preferred
Pay Range
USD $37.32 - USD $46.66 /Hr.
About Us
VNS Health has been committed to meeting the needs of New Yorkers for over 130 years. We're one of the largest nonprofit home- and community-based health care organizations in the country, and today, more than 11,500 team members work together to make a difference in the lives of more than 99,000 patients and members on any given day.
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VNS Health
paid time off, tuition reimbursement, 401(k)
Sep 10, 2026