Managed Care Specialist

Managed Care Contracting Specialist (NV or UT) Remote

Residing in Clark/Nye/Washoe County, NV or Salt Lake County/Utah County, UT

Department

Provider Network Management

Reports To

Senior Manager, Provider Network Management

FLSA Status

Non-Exempt

Position Summary

The Managed Care Network Development Specialist is responsible for provider recruitment, network expansion, and contracting activities to support the growth and maintenance of the organization's provider network across multiple states. This role identifies network adequacy gaps, recruits physicians, hospitals, facilities, and ancillary providers, negotiates participation agreements, and manages provider onboarding through contract execution and credentialing completion.

Essential Responsibilities

• Identify, recruit, and contract physicians, hospitals, ancillary providers, behavioral health providers, and healthcare facilities.
• Research provider markets and develop recruitment strategies to address specialty and geographic network gaps.
• Negotiate provider participation agreements and Letters of Agreement (LOAs).
• Analyze provider networks to identify access and availability deficiencies.
• Develop relationships with physician practices, health systems, and hospital contracting departments.
• Coordinate with internal departments to ensure timely provider onboarding.
• Prepare weekly and monthly network development and contracting reports.
• Respond to provider inquiries regarding contracting and credentialing status.
• Support compliance with network adequacy, HIPAA, and regulatory requirements.
• Travel as needed to recruit providers and support network expansion.

Required Qualifications

• 3+ years in provider network development, provider contracting, provider relations, or managed care operations.
• Experience recruiting and contracting physicians, hospitals, and ancillary providers.
• Knowledge of Medicare Advantage, Medicaid, Commercial, or ACA networks.
• Strong communication, negotiation, and relationship-building skills.
• Proficiency in Microsoft Excel, Word, and Outlook.

Preferred Qualifications

• Multi-state provider contracting experience.
• Knowledge of network adequacy standards.
• Experience with provider credentialing and onboarding.
• Existing provider relationships in Utah or Nevada.